Ultrasound‐Guided Percutaneous Peritoneal Dialysis Catheter Insertion With Musculofascial Tunnelling Reduces Catheter Migration—Observational Retrospective Cohort Study

AIM: Peritoneal dialysis catheter migration causes treatment interruption and impacts outcome. Musculofascial tunnelling during peritoneal dialysis catheter insertion has been proposed as a technique to improve catheter stability, but evidence supporting its effectiveness remains limited. This study evaluated the impact of musculofascial tunnelling during percutaneous peritoneal dialysis catheter insertion on catheter migration and related complications. METHODS: This is a retrospective cohort study on 247 subjects with end stage kidney disease who underwent percutaneous peritoneal dialysis catheter insertion at two centres using ultrasound-guided percutaneous Seldinger technique from 1 January 2022 to 31 December 2023. We compared outcomes between 134 subjects who had musculofascial tunnelling and 113 subjects who did not have musculofascial tunnelling. The primary outcome was 1-year catheter tip migration-free survival. Survival analysis was compared using Kaplan-Meier estimate and confounding factors adjusted with Cox regression model. Time 0 was defined as date of peritoneal dialysis catheter insertion. RESULTS: Overall success rate of percutaneous peritoneal dialysis catheter insertion was 96.0%. One-year catheter migration-free survival was higher in the musculofascial tunnelling group compared to the non-musculofascial tunnelling group (p = 0.003). In multiple variable weighted Cox regression model, the only independent predictor of catheter migration was the absence of tunnelling. No significant differences were observed in early catheter insertion related complications, overall patient survival, peritoneal dialysis associated peritonitis-free survival and time on peritoneal dialysis therapy at 1 year. CONCLUSION: Incorporating musculofascial tunnelling technique into percutaneous peritoneal dialysis catheter insertion reduces catheter migration. This technique is safe with low rates of complications.