Authors (including presenting author) :
Ho TLE (1), Chan ML(2), Leung TWJ(2), IP THJ(1), Yeung SJ(1), Tsang WCS(1)
Affiliation :
(1) Department of Medicine, Tseung Kwan O Hospital (2) Haemodialysis Centre, Department of Medicine, Tseung Kwan O Hospital
Introduction :
Traditionally, patients opt for long term peritoneal dialysis (PD) will have Tenkchoff catheter (TKC) insertion by urologist via mini-laparotomy technique. TKC insertion with seldinger technique is another option which is adopted in KEC renal service and done by nephrologist. Usually patients will be managed and observed overnight as in-patients post-operatively.
Objectives :
With the surge of COVID-19 cases in 2020 and tight in-patient occupancy, we modified the protocol and facilitated the same day discharge for patients having TKC insertion via seldinger technique in Tseung Kwan O Hospital (TKOH).
Methodology :
Patients were instructed to have pre-operative blood tests within one week prior to TKC insertion and attend renal day center (RDC) in TKOH at 8am on operation days. TKC insertion was done by nephrologist via seldinger technique in RDC. Patients stayed in the ambulatory center post-operatively for close monitoring. TKC was flushed with low volume dialysate with patient in recumbent position to minimize intra-abdominal pressure. Meals were allowed in sitting position after drainage of PD fluid. Analgesic was given whenever necessary. KUB was taken to confirm catheter position. Nephrologist would be informed if patient had unstable hemodynamics, severe wound pain, significant wound bleeding or heavily blood stained effluent. Patients could be discharged home on same day if conditions were stable. They were reviewed in RDC the day afterwards for wound care and weekly RFT monitoring +/- commencement of intermittent PD.
Result & Outcome :
From Jan 2020 to Dec 2021, 106 patients had elective TKC insertion, 69 (65%) were admitted to RDC and done by nephrologist with seldinger technique. Thirty-eight patients (55%) were male and 32 patients (46.4%) had diabetes mellitus. Mean hemoglobin and creatinine were 8.8±1.38g/dL and 758.1±226.7umol/L respectively. Median operation time was 47minutes (IQR 41-52minutes). There were no major complications which required urgent surgical intervention. Thirty-nine percent (11/28) patients were discharged same day in 2020 and the percentage was increased to 71% (29/41) in 2021. Male and patient with age<65 were the significant factors favor same day discharge, p=0.015 and p=0.001 respectively. The average length of stay of patients having TKC insertion via seldinger technique was 1.13 day which was shorter than those with mini-laparotomy of 1.46 day (p=0.022). Conclusions: TKC insertion with seldinger technique by nephrologist done in RDC is safe and less traumatic, hence facilitates same day discharge and reduces in-patient admission and hospital cost.
