REGULAR CONTENT
Final ID
510
Type
Original Scientific Research-Oral or Pos
Authors
J Knight1, S Thompson2, C Fleming2, E Bendel2, M Neisen2, N Neidert2, A Stockland2, J Friese2, H Bjarnason2, D Woodrum2
Institutions
1Mayo Medical School, Rochester, MN, 2Mayo Clinic, Rochester, MN
Purpose
To determine the safety and effectiveness of tunneled peritoneal catheter placement in the management of refractory malignant and non-malignant ascites.
Materials & Methods
An IRB-approved retrospective review was undertaken of all patients who underwent ultrasound/fluoroscopy-guided tunneled peritoneal catheter placement for management of refractory malignant ascites or non-malignant ascites (i.e. heart failure and/or portal hypertension) between 1/1/2009 and 3/14/2014.
Results
One hundred thirty-seven patients (76M/61F, mean age 62.9 years) underwent tunneled peritoneal catheter placement for management of refractory malignant (N=119; 86.9%) or non-malignant (N=18; 13.1%) ascites. Technical success was 100% and mean (±SD) volume of ascites drained at the procedure was 2.5 ± 1.4L. There were no immediate complications. During follow-up, no patient required concomitant paracentesis. Nineteen patients (13.9%) experienced a total of 11 minor and 12 major complications. Nine patients developed a catheter-associated infection with drain site cellulitis (N=3) or bacterial peritonitis (N=6). The remaining complications included leakage at the dermatotomy site (N=8), catheter dislodgement (N=2), obstruction (N=2), and groin pain (N=2). Five patients required catheter exchange. Patients who developed a catheter-associated infection had a significantly longer catheter dwell time compared to those who did not develop an infection (median, 96.5 days versus 20 days, respectively; p<0.01). Nine patients were lost to follow-up. Of the remaining 128 patients, 125 died, and the majority had a catheter in place (90.4%) at the time of death. There was one catheter-associated death (bacterial peritonitis; 0.8%). The median time from catheter placement to death was significantly shorter in patients with malignant versus non-malignant ascites (18.5 versus 85 days, respectively; p<0.0001).
Conclusions
Palliative tunneled peritoneal drainage catheters are effective and relatively safe in the management of both malignant and non-malignant ascites. Longer catheter dwell time may be a risk factor for catheter-associated infection, particularly in patients with a longer anticipated survival in the palliative setting.
Final ID
510
Type
Original Scientific Research-Oral or Pos
Authors
J Knight1, S Thompson2, C Fleming2, E Bendel2, M Neisen2, N Neidert2, A Stockland2, J Friese2, H Bjarnason2, D Woodrum2
Institutions
1Mayo Medical School, Rochester, MN, 2Mayo Clinic, Rochester, MN
Purpose
To determine the safety and effectiveness of tunneled peritoneal catheter placement in the management of refractory malignant and non-malignant ascites.
Materials & Methods
An IRB-approved retrospective review was undertaken of all patients who underwent ultrasound/fluoroscopy-guided tunneled peritoneal catheter placement for management of refractory malignant ascites or non-malignant ascites (i.e. heart failure and/or portal hypertension) between 1/1/2009 and 3/14/2014.
Results
One hundred thirty-seven patients (76M/61F, mean age 62.9 years) underwent tunneled peritoneal catheter placement for management of refractory malignant (N=119; 86.9%) or non-malignant (N=18; 13.1%) ascites. Technical success was 100% and mean (±SD) volume of ascites drained at the procedure was 2.5 ± 1.4L. There were no immediate complications. During follow-up, no patient required concomitant paracentesis. Nineteen patients (13.9%) experienced a total of 11 minor and 12 major complications. Nine patients developed a catheter-associated infection with drain site cellulitis (N=3) or bacterial peritonitis (N=6). The remaining complications included leakage at the dermatotomy site (N=8), catheter dislodgement (N=2), obstruction (N=2), and groin pain (N=2). Five patients required catheter exchange. Patients who developed a catheter-associated infection had a significantly longer catheter dwell time compared to those who did not develop an infection (median, 96.5 days versus 20 days, respectively; p<0.01). Nine patients were lost to follow-up. Of the remaining 128 patients, 125 died, and the majority had a catheter in place (90.4%) at the time of death. There was one catheter-associated death (bacterial peritonitis; 0.8%). The median time from catheter placement to death was significantly shorter in patients with malignant versus non-malignant ascites (18.5 versus 85 days, respectively; p<0.0001).
Conclusions
Palliative tunneled peritoneal drainage catheters are effective and relatively safe in the management of both malignant and non-malignant ascites. Longer catheter dwell time may be a risk factor for catheter-associated infection, particularly in patients with a longer anticipated survival in the palliative setting.