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Use of a flexible Blake® silicone drains for peritoneal dialysis in the neonatal intensive care unit

While peritoneal dialysis (PD) has been applied for acute renal failure in neonates recently, catheter-related complications, such as peritonitis, catheter obstruction, entry-site infection and leakage, still remain. We adopted a single flexible 10-Fr Blake silicone drains with four non-luminal, fluted side-channels (Ethicon, Inc., Sommerville, NJ, USA) as a PD catheter for our two neonatal intensive care unit patients. Furthermore, we devised a surgical placement procedure to prevent catheter occlusion and leakage of instilled dialysate during PD. The first patient was delivered by emergency cesarean section due to placental abruption at 40 weeks’ gestation and the patient had cerebral hypoxia-ischemia after birth. On day 4, acute renal failure developed and PD was required at bedside (Fig. 1a). Adequate ultrafiltration was maintained via a single catheter. Two days after initiation, the urinary output recovered and PD was completed. The second patient was an extremely-lowbirthweight (ELBW) infant who was delivered at 22 weeks’ gestation with a birthweight of 520 g. Compromised circulation persisted and oliguria progressing to anuria was refractory to cardiovascular medications after patent ductus arteriosus (PDA) ligation. On day 41 (618 g bodyweight), emergency bedside PD was required (Fig. 1b). Although ultrafiltration was adequate and no major complication related to PD was observed, there was no significant improvement in hemodynamics and the patient died 2 days after the initiation of PD. This multipurpose 10-Fr flexible Blake silicone drains catheter is now widely used for drainage in various surgeries. It has four fluted side-channels, instead of holes, to promote efficient drainage along its entire intraperitoneal length by capillarity. Even if the tip of the catheter migrates, the efficacy of drainage is maintained. The catheter has a transitional segment that converts side channels to a catheter with a central lumen for connection to a standard closed PD system. The first description of the use of this catheter for acute PD was by Orak et al. in five infants who weighed from 1.9 to 8 kg. None of the patients in that series showed a loss of catheter function due to catheter occlusion. In general, access to the peritoneal cavity is achieved by a single small-laparotomy and the catheter is placed into the abdominal cavity from the same laparotomy wound. The opening of the peritoneum is tightened around the catheter by a pursestring suture. This placement modality sometimes allows the early leakage of dialysis fluid from the entry-site. In our unique surgical procedure, the entry-site was created by a small wound and no purse-string suture on the peritoneal membrane was required at the catheter entry-site. A “tiny stab wound” for the catheter entry-site contributed most to the prevention of dialysate leakage (Fig. 1c–f). While percutaneous catheter implantation is a quick procedure, it requires experience and meticulous attention. Therefore, we select surgical catheter implantation for safety. Long-term results of using this catheter should be confirmed in a prospective and randomized study; however, our experience shows that a single Blake silicone drains catheter was associated with fewer complications and can be considered as an option for acute PD in the neonatal intensive care unit.