Fraser Health nephrologist Dr. Victor Chan has almost certainly performed more bedside catheter insertions than any other physician in this country, and possibly more than any physician in any country.
Catheters are the flexible tubes used in peritoneal dialysis (PD) for carrying dialysis fluid into and out of the patient’s abdomen. In other provinces, most PD catheters are implanted by surgeons using operating room facilities. In BC, specially trained nephrologists at Royal Columbian, Vancouver General and St. Paul’s hospitals implant catheters using a relatively uncomplicated bedside procedure with the patient under local anesthetic. BCPRA is supporting an initiative to expand the bedside insertion procedure across the province.
“You have to have the right aptitude and like to fiddle with things to have an interest in doing these insertions,” says Chan. “It’s not something all nephrologists want to do.”
Among Fraser Health’s 12 nephrologists, four have chosen to perform the insertions, under the tutelage of Chan. Last year Chan and his colleagues inserted 104 catheters at the bedside, leaving just 16 insertions to be done through surgery.
There are good reasons for supporting the bedside procedure. At Fraser Health, the waiting time for a beside catheter insertion is usually under two weeks. The procedure typically takes only 20 minutes, and the patient is able to go home the same day. By comparison, the waiting time for patients to have the same procedure done through surgery can take three months, with patients also requiring an overnight stay in hospital.
Chan first learned to perform bedside insertions at Vancouver General Hospital in the late 1960s, when the first catheters designed for implantation were developed. In 1972 he was part of the team that started the hemodialysis unit at Royal Columbian Hospital. However his support for peritoneal dialysis never wavered, and he has led the Fraser peritoneal dialysis team through their ongoing development.
“Unlike some places that treated PD as the poor cousin of hemodialysis, we have always done PD and were able to keep up with a certain degree of practice for PD patients as the treatment became more popular,” says Chan. Fraser Health has the largest PD program in the province, with about 240 patients – about a third of its total number of patients on dialysis. By comparison, in Ontario only 18 percent of dialysis patients are on PD, while south of the border, PD accounts for only eight percent of all dialysis.
Although he has no thoughts yet of retirement, Chan’s interests are not confined to his medical practice. He is an accomplished painter, trained in the Chinese style of watercolour painting, and produces about 100 paintings a year. He says the same steady hand required for the detailed technical procedures involved in catheter insertions is also helpful for producing the fine details in his paintings.
“You have to be pretty good with your hands to insert catheters,” says Chan. “I’m good at painting, so it’s not hard for me.”