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796 Palmer’s Point for Safe Insertion of Percutaneous Dialysis Catheter in Neonates
  1. B Banieghbal
  1. Paediatric Surgery, Netcare and Life Health Care Hospital Groups, Johannesburg, South Africa


Background and Aim Acute renal failure occasionally occurs in neonates secondary to generalized sepsis or major cardiac surgery. Insertion of a peritoneal dilyasis (PD) catheter is needed in majority of cases. Open laparotomy techniques are prone to bleeding and dialysate leakage. Percutaneous bed-side insertion of PDs is the preferred method in our setting.

Methods In a retrospective study, over a 8-year period, neonatal PDs were inserted using Palmer’s point at the bed-side in intensive care unit. Plamer’s point is an anatomical landmark; it is on the left anterior axillary line and just in front of the 10th rib. This point is known to have the least amount of adhesions and therefore blind insertion of catheters and trocars are least likely to cause iatrogenic gut perforations.

Results 51 PDs were inserted in that period; in 7 cases pervious gastrostomy or pacemaker forced an insertion of PD in the right hypochondrium resulting in 2 minor liver injuries. The remaining 44 PDs using Palmer’s point were successfully placed. Dialysis was carried out for 2 weeks on average and was successful in controlling renal failure in all cases. However, in the long-term, 12 patients succumb to their septic, respiratory or cardiac lesions subsequently.

Conclusion Percutaneous bed-side insertion of PD catheter in neonates is possible, safe and successful using Palmer’s point.

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