Open Versus Percutaneous Insertion of CAPD Catheters
Recruitment status was: Not yet recruiting
Healthy kidneys clean your blood by removing excess fluid, minerals, and wastes. When your kidneys fail, harmful wastes build up in your body and your body may retain excess fluid. When this happens, you need treatment to replace the work of your failed kidneys. This may be with a dialysis machine using haemodialysis or with fluid in the abdomen or peritoneal dialysis.
In peritoneal dialysis, a tube called a catheter is put in the abdomen wall and used to fill your abdomen with a cleansing liquid called dialysis solution. The walls of your abdominal cavity are lined with a membrane called the peritoneum, which allows waste products and extra fluid to pass from your blood into the dialysis solution. These wastes and fluid are removed from the body when the dialysis fluid is drained and replaced with a fresh solution.
The tubes or catheters used to exchange the fluid are currently positioned using a general anaesthetic (with the patient awake) and an operation with a cut under the belly button. Newer techniques using local anaesthetic (with the patient awake and the area numbed) and requiring only a small cut in the skin have been used. No one has ever directly compared the two techniques.
The investigators aim is to perform a direct comparison between the two techniques to look at the complications and time required for surgery and length of hospital stay required. The investigators will also look at the patients satisfaction and pain scores with each technique to help gather evidence as to which is likely to be the best technique to use from now on.
|Renal Failure||Procedure: Percutaneous Insertion catheter Procedure: Open insertion Catheter|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||A Prospective Randomized Controlled Trial of Local Anaesthetic Percutaneous Insertion Versus General Anaesthetic Open Surgical Placement of Continuous Peritoneal Dialysis Catheters in a University Teaching Hospital|
- Catheter survival [ Time Frame: Ongoing (recorded at 6 month intervals) ]Time to catheter removal for any reason.recorded as percentage inn situ at 6, 12,18,etc months post procedure.
- Peri operative complications (bleeding, bowel injury) [ Time Frame: 24 hrs post procedure ]All complications occuring at time of procedure and in 24 hours immediately post procedure.
- Mechanical Complication (drainage failure, displacement, fluid leak) [ Time Frame: ongoing (reported at 30 days and monthly thereafter) ]All mechanical complications recorded during follow up period. Note of timing of complications will be made in results. Early = within 30 days, late = beyond 30 days
- Infective complications (exit site, tunnel, peritonitis) [ Time Frame: ongoing (reported at 30 days and monthly thereafter) ]All infective complications recorded during follow up period. Note of timing of complications will be made in results. Early = within 30 days, late = beyond 30 days
- Operative time [ Time Frame: Average of 2 hours post procedure ]Time to complete procedure from start to finish.
- Technical Success of placement [ Time Frame: Average of 2 hours post procedure ]Assessment of whether a working and useable catheter is in situ at the end of the procedure.
- Length of admission [ Time Frame: Average of 48 hours post procedure ]Length of admission post procedure according to strict discharge criteria.
- Patient reported pain post procedure [ Time Frame: 24 hour intervals to 5 days post procedure ]Analgesia and daily pain scoring diaries will be issued to patients post procedure. These will record patient reported pain at 24 hour intervals to 5 days as well as analgesia taken during the same period.
- Quality of life assessment by questionnaire [ Time Frame: Within 24 hours prior to procedure, and again at both 5 days and 3 months post procedure ]
- Estimated cost of care episode [ Time Frame: 3 months post procedure ]Overall estimated cost of admission, procedure, ongoing care of catheter and management of complications arising from catheter or procedure will be calculated.
|Study Start Date:||December 2011|
|Estimated Study Completion Date:||September 2012|
|Estimated Primary Completion Date:||July 2012 (Final data collection date for primary outcome measure)|
Active Comparator: Percutaneous insertion
To undergo insertion of catheter using percutaneous technique under local anaesthetic
Procedure: Percutaneous Insertion catheter
Insertion of CAPD catheter using percutaneous seldinger technique under local anaesthetic +/- sedation as required
Active Comparator: Open insertion
To undergo insertion of catheter using open technique under general anaesthetic
Procedure: Open insertion Catheter
Present technique of open insertion under general anaesthetic. Incision to lower abdomen and direct visualisation of catheter tip placement into pelvis.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01023191
|Contact: George E Smith, MBBS||++44 1482 email@example.com/uk|
|Contact: Ian C Chetter, MB ChB||++44 1482 firstname.lastname@example.org|
|Hull Royal Infirmary||Not yet recruiting|
|Hull, East Yorkshire, United Kingdom, HU3 2JZ|
|Contact: Ian C Chetter, MBChB FRCS MD +44 1482 674643 email@example.com|
|Contact: George E Smith, BSc MBBS MRCS +44 1482 674643 firstname.lastname@example.org|
|Principal Investigator:||Ian C Chetter, MB ChB||University of Hull|