Questions About PD Catheter Placement During COVID-19?

We’ve Got Answers.

The American Society of Nephrology (ASN) contends that CMS guidelines call for dialysis access, including PD catheter placement to be essential, non-elective surgery.1 

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CMS UPDATE:

PD Catheter Placement Procedures, August 2020

"CMS previously released guidance to defer non-essential planned surgical procedures. Following the release of this guidance, we have received feedback that providers are experiencing difficulties scheduling for placement or repair of Arteriovenous Fistulas, Arteriovenous grafts, and Peritoneal Dialysis catheters. We wish to clarify that these planned procedures are essential in that establishing vascular access is crucial for End Stage renal Disease (ESRD) patients to receive their life-sustaining dialysis treatments."

What resources exist for surgeons, interventional radiologists and nephrologists placing PD catheters?

Vantive PD Excellence Academy has live and on-demand webinars on PD access and catheter placement, featuring leaders in the nephrology community.

Kidney Dialysis
PD Access Catheters and Placement
Watch video
Kidney Dialysis
PD Catheter Placement Using Ultrasound and Fluoroscopic Guidance
Watch video

In light of the uncertainty COVID-19 brings, what proactive steps can be taken to start patients on PD?

Embedded placement of PD catheters can be an option for patients looking to start on PD. This is the prophylactic insertion of PD catheters, with the external portion of the catheter capped and embedded in the subcutaneous tissue in the anterior abdominal wall so that the catheter can be readily accessed and used in cases of sudden deterioration in kidney function. Careful consideration of benefits/risks for early placement of embedded catheters should be applied.

Potential Benefits:

• Flexibility in timing of PD start and PD education

• Low rate of infectious complications

• Low risk of leaks

• Decreased resource utilization as compared to managing a crash patient start with a CVC

Potential Risks:

• Catheter may not be used if condition changes or patient changes his/her modality preference

• Risk of malfunction the longer the catheter remans embedded without being used2

Need additional support on PD catheter implantation, PD therapy or PD products?

Call 1-800-284-4060 for your local Vantive representative who can provide resources that help you grow your PD program.

References

  1. Centers for Medicare & Medicaid Services, August 17, 2020. https://www.cms.gov/files/document/qso-20-36-esrd.pdf.

  2. McCormick BB, et al. Use of the embedded peritoneal dialysis catheter: experience and results from a North American Center.  Kidney Int Suppl. 2006;(103):S38-S43. doi:10.1038/sj.ki.5001914 QxMD: https://read.qxmd.com/read/17080110.use-of-the-embedded-peritoneal-dialysis-catheter-experience-and-results-from-a-north-american-center.