From the Guidelines
A Tenckhoff Peritoneal Catheter (TPC) is typically inserted at the bedside using a tunneled technique, providing access to the pleural space for fluid drainage when symptoms recur.
Key Points
- The insertion of a TPC is often performed in an ambulatory setting via a tunneled technique, as stated in the study by 1.
- This method allows for less invasive means to reduce dyspnea and improve quality of life (QOL) in patients with malignant pleural effusions.
- The study by 1 reports that 96% of patients derived symptomatic relief from TPC insertion, with a low rate of major complications.
- While the evidence does not directly compare bedside insertion to operating room (OR) insertion, the ambulatory setting is implied as the standard location for TPC insertion.
- It is essential to note that the provided evidence focuses on the management of malignant pleural effusions, and the context of TPC insertion may vary depending on the specific clinical scenario.
From the Research
Tenckhoff Peritoneal Catheter Insertion Methods
The insertion of a Tenckhoff Peritoneal Catheter (TPC) can be performed using different methods, including bedside insertion and insertion in the Operating Room (OR).
- Bedside insertion: This method involves the insertion of the TPC at the patient's bedside, often using a trocar under local anesthesia 2, 3, 4.
- Operating Room (OR) insertion: This method involves the insertion of the TPC in the OR, which may be performed using laparoscopic techniques 5 or open surgery 6.
Comparison of Insertion Methods
The choice of insertion method may depend on various factors, including the patient's medical condition, the availability of equipment and personnel, and the physician's preference.
- Bedside insertion has been shown to be a safe and effective method, with comparable outcomes to surgical techniques 2.
- Laparoscopic insertion in the OR has also been shown to be a safe and effective method, with a low risk of complications 5.
- Open surgery in the OR may be used in certain cases, such as when there are abdominal problems or other contraindications to bedside insertion 6.
Specific Studies
Several studies have reported on the outcomes of TPC insertion using different methods.
- A study published in 1999 reported on the outcomes of 54 TPC insertions using a bedside technique, with a cumulative survival rate of 91% at one year and 68% at four years 2.
- A study published in 2012 reported on the outcomes of 403 TPC insertions using a blind peritoneal catheter placement technique, with an intervention-free survival rate of 84.5% at one year and 63.3% at five years 3.
- A study published in 2011 reported on the outcomes of 114 TPC insertions using a bedside technique, with a success rate of 99.1% and a low rate of complications 4.
- A study published in 2006 reported on the outcomes of 13 TPC insertions using a laparoscopic technique in the OR, with a low rate of complications and no cases of hernia or leaking 5.