ANZDATA for 2007 has shown >26% of patients in the Top End of Northern Territory commencing dialysis chose PD first. In the past 50% of patients have presented with inadequate or no access for treatment. This necessitated the insertion of a central line and emergency dialysis. The lack of a ready access is well recognised as a cause of poor long term survival and reduced quality of life.
A buried catheter programme was initiated in Darwin in February 2006 and more than 60 catheters have now been buried. The aim of the programme is to better prepare patients for renal replacement therapy and to allow for planning within the PD unit for training and the commencement of dialysis before the patient becomes acutely ill.
Historically, patients have been reluctant to commit to PD as their first dialysis option due to the risk of infection and the many circulating stories built around misinformation.
The insertion of a buried catheter gives the patient and their family opportunity to understand their diagnosis, removes the care, maintenance and associated risks of infection with an unburied catheter.
An unexpected benefit has been for those patients on haemodialysis who have rapidly run out of vascular access options. A buried catheter was inserted and a period of healing followed. When the vascular access was no longer an option the buried catheter was exteriorised and PD was commenced, thereby prolonging life and reducing the risks of central line infections.