Peritoneal Dialysis Access: Prospective Randomized Comparison of the Swan Neck and Tenckhoffcatheters

1995 ◽  
Vol 15 (4) ◽  
pp. 353-356 ◽  
Author(s):  
Björn H. Eklund ◽  
Eero O. Honkanen ◽  
Aino-Riitta Kala ◽  
Lauri E. Kyllönen
Keyword(s):  
Peritoneal Dialysis ◽  
Infectious Complications ◽  
University Hospital ◽  
Dialysis Access ◽  
Exit Site ◽  
Peritoneal Catheter ◽  
Catheter Survival ◽  
Catheter Migration ◽  
The Impact ◽  
To Receive

Objective To examine the impact of peritoneal catheter configuration on mechanical complications, catheter survival, probability of episodes of peritonitis, and probability of exit -site infections associated with the use of catheters for continuous ambulatory peritoneal dialysis (CAPD). Design Prospective randomized trial. Setting CAPD unit in one university hospital, serving a population of 1.2 million. Patients Forty consecutive patients requiring their first dialysis catheter for future CAPD were randomized to receive either a two-cuff permanently bent Swan neck catheter or a two-cuff straight Tenckhoff catheter. The skin exit was downward-directed in the Swan neck group and upward-directed in the Tenckhoff group. Results Dialysate leak, catheter migration, or tunnel infection did not occur in any of the patients. Three outer cuff extrusions needing cuff shaving occurred, all in the Tenckhoffgroup(p =0.1). No significant differences could be demonstrated in catheter survival at 2 years, probability of episodes of peritonitis, or probability of exit-site infections. Conclusion Catheter configuration did not influence the catheter-related mechanical or infectious complications, and equally good results were obtained with both catheter types studied.

Catheter Configuration and Outcome in Patients on Continuous Ambulatory Peritoneal Dialysis: A Prospective Comparison of Two Catheters

1994 ◽  
Vol 14 (1) ◽  
pp. 70-74 ◽  
Author(s):  
Björn H. Eklund ◽  
Eero O. Honkanen ◽  
Aino-Riitta Kala ◽  
Lauri E. Kyllönen
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Infectious Complications ◽  
University Hospital ◽  
Exit Site ◽  
Catheter Survival ◽  
Tenckhoff Catheter ◽  
Prospective Comparison ◽  
Catheter Tip ◽  
The Impact

Objective To examine the impact of peritoneal catheter configuration on mechanical complications, catheter survival, probability of episodes of peritonitis, and probability of exit-site infections associated with the use of catheters for continuous ambulatory peritoneal dialysis (CAPD). Design Prospective randomized trial. Setting CAPD unit in one university hospital. Patients Forty consecutive patients requiring a dialysis catheter for future CAPD were randomized to receive either a single-cuff straight Tenckhoff catheter or a permanently bent single-cuff Swan neck catheter. The skin exit was upward-directed in the Tenckhoff group and downward-directed in the Swan neck group. Results Dialysate leak occurred in one patient and symptomatic catheter tip migration in 3 patients with the Tenckhoff catheter but in none with the single-cuff Swan neckcatheter(p=O.5, p=0.12). No significant differences in catheter survival at 2 years, probability of episodes of peritonitis, or probability of exit-site infections could be demonstrated. Conclusion Catheter configuration did not influence the catheter-related mechanical or infectious complications. We were unable to demonstrate any advantage of the newer, permanently bent single-cuff Swan neck catheter over the conventional straight type.

Comparison of Straight and Curled Tenckhoff Peritoneal Dialysis Catheters Implanted by Percutaneous Technique: A Prospective Randomized Study

1995 ◽  
Vol 15 (1) ◽  
pp. 18-21 ◽  
Author(s):  
Palle K. Nielsen ◽  
Claus Hemmingsen ◽  
Steffen U. Friis ◽  
Jorgen Ladefoged ◽  
Klaus Olgaard
Keyword(s):  
Peritoneal Dialysis ◽  
Randomized Study ◽  
Infectious Complications ◽  
University Hospital ◽  
Percutaneous Technique ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Catheter Survival ◽  
The Difference ◽  
The Impact

Objective To examine the impact of peritoneal dialysis catheter configuration, curled or straight catheter, on catheter survival and mechanical and infectious complications. Design Prospective randomized trial. Setting Department of Nephrology of a single university hospital. Patients Seventy-two consecutive patients initiating peritoneal dialysis were randomized to receive either a single cuff straight catheter or a single cuff curled catheter, implanted by percutaneous technique. Results Significantly higher (p < 0.01) survival rate of the curled as compared to the straight catheter. The difference in catheter survival was due to a significantly higher (p < 0.01) incidence of drainage failure associated with catheter tip migration of the straight catheter than of the curled catheter. No difference in infectious complication between the two types of catheters was seen. Catheter survival at 12 months was 77% for the curled catheter and 36% for the straight catheter. Conclusion This study demonstrates superiority of the curled Tenckhoff peritoneal dialysis catheter survival as compared to the straight catheter. This difference in catheter survival is due to the higher displacement rate of the straight catheter.

A Prospective Randomized Comparison of the Swan Neck, Coiled, and Straight Tenckhoff Catheters in Patients on Capd

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 333-335 ◽  
Author(s):  
Wai-Choong Lye ◽  
Nam-Wee Kour ◽  
Jane C. Van Der Straaten ◽  
See-Odd Leong ◽  
Evan J.C. Lee
Keyword(s):  
Exit Site ◽  
Peritoneal Catheter ◽  
Exit Site Infection ◽  
Patient Dropout ◽  
Mechanical Complications ◽  
Catheter Group ◽  
Significant Difference ◽  
Catheter Tip ◽  
The Impact ◽  
To Receive

Our objective was to study the impact of peritoneal catheter configuration on continuous ambulatory peritoneal dialysis (CAPO)-related infections, mechanical complications, and patient dropout in a prospective randomized trial. Forty consecutive patients who were commencing CAPO were randomized to receive either a double-cuff, Swan neck coiled catheter or a double-cuff, straight Tenckhoff catheter, implanted by surgical technique. There was no significant difference in the peritonitis rate between the two groups. There was a lower rate of exit-site infection in the Swan neck group compared to the straight catheter group (0.29 vs 0.60 eplsodes/patientyear, p < 0.05). Catheter-tip migration occurred in 3 patients with the straight catheters compared to one patient with the Swan neck catheter. No patient had to discontinue CAPO because of mechanical complications. The number of CAPO patient dropouts was not significantly different between the two groups. The Swan neck configuration resulted in a significant reduction in the rate of exit-site infections. The coiled component of the catheter may lead to fewer episodes of catheter-tip migration. However, catheter configuration did not influence the number of technique failures.

scholarly journals Advanced Laparoscopic Peritoneal Dialysis Catheter Insertion: Systematic Review and Meta-Analysis

2018 ◽  
Vol 38 (3) ◽  
pp. 163-171 ◽  
Author(s):  
Badri M. Shrestha ◽  
Donna Shrestha ◽  
Avneesh Kumar ◽  
Alice Shrestha ◽  
Simon A. Boyes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Peritoneal Dialysis ◽  
Cohort Studies ◽  
Meta Analysis ◽  
Infectious Complications ◽  
Peritoneal Dialysis Catheter ◽  
Exit Site ◽  
Catheter Survival ◽  
Catheter Obstruction ◽  
Advanced Laparoscopy

BackgroundThe optimal methodology of establishing access for peritoneal dialysis (PD) remains controversial. Previously published randomized controlled trials and cohort studies do not demonstrate an advantage for 1 technique over another. Four published meta-analyses comparing outcomes of laparoscopic versus open PD catheter (PDC) insertion have given inconsistent conclusions and are flawed since they group basic and advanced laparoscopy together. The aim of this systematic review and meta-analysis is to examine whether advanced laparoscopic interventions consisting of rectus sheath tunneling and adjunctive procedures produce a better outcome than open insertion or basic laparoscopy used only to verify the catheter position.MethodsA literature search using Medline, Embase, and Cochrane Database was performed, and meta-analysis was performed using RevMan 5.3.5 software (Nordic Cochrane Centre, The Cochrane Collaboration, London, UK). Outcomes evaluated incidence of catheter obstruction, migration, pericannular leak, hernia, infectious complications (peritonitis and exit-site infection) and catheter survival.ResultsOf the 467 records identified, 7 cohort studies, including 1,045 patients, were included in the meta-analysis. When advanced laparoscopy was compared with open insertion, a significant reduction was observed in the incidence of catheter obstruction (odds ratio [OR] 0.14, 95% confidence interval [CI] 0.03 – 0.63; p = 0.01), catheter migration (OR 0.12, 95% CI 0.06 – 0.26; p = 0.00001), pericannular leak (OR 0.27, 95% CI 0.11 – 0.64; p = 0.003), and pericannular and incisional hernias (OR 0.29, 95% CI 0.09 – 0.94; p = 0.04), as well as better 1- and 2-year catheter survival (OR 0.52, 95% CI 0.28 – 0.97; p = 0.04 and OR 0.50, 95% CI 0.28 – 0.92; p = 0.03, respectively). Compared with basic laparoscopy, catheter obstruction and migration were significantly lower in the advanced laparoscopic group, whereas catheter survival was similar in both groups. All outcomes, except catheter obstruction, were similar between the basic laparoscopy and open insertion. The infectious complications such as peritonitis and exit-site infections were similar between the 3 groups.ConclusionsAdvanced laparoscopy was associated with a significant superior outcome in comparison with open insertion and basic laparoscopy.

Staphylococcus Aureus Peritoneal Catheter-Related Infections: A Cause of Catheter Loss and Peritonitis

1988 ◽  
Vol 8 (3) ◽  
pp. 191-194 ◽  
Author(s):  
Stephen W. Zimmerman ◽  
Mark O'Brien ◽  
Frances A. Wiedenhoeft ◽  
Curtis A. Johnson
Keyword(s):  
Staphylococcus Aureus ◽  
Peritoneal Dialysis ◽  
Host Factors ◽  
High Recurrence Rate ◽  
Coagulase Negative Staphylococcus ◽  
Exit Site ◽  
Peritoneal Catheter ◽  
Patients At Risk ◽  
Catheter Infections ◽  
The Impact

To determine the impact of Staphylococcus aureus catheter-related infections in a peritoneal dialysis program we reviewed all S. aureus catheter-related infections in our program over a six-year period. Twenty -five percent (51/204) of patients at risk developed S. aureus catheter exit-site or tunnel infections. S. aureus accounted for 61% of all positive exit-site cultures; of 320 catheters implemented, 65 were infected with S. aureus. Fifty-one S. aureus-infected patients were retrospectively matched with 51 noninfected patients from our peritoneal dialysis program. Patients with S. aureus catheter-related infections had significantly greater catheter loss from catheter infection and peritonitis. There was significantly more S. aureus peritonitis but less coagulase negative staphylococcus peritonitis in patients with S. aureus catheter-related infections. Significantly more noninfected control patients remained peritonitis free. During this period, 83% of all S. aureus peritonitis was associated with S. aureus catheter infections, and 28 of 57 replacement catheters were reinfected with S. aureus. These findings suggest S. aureus is a major catheter-related pathogen leading to catheter loss and peritonitis. The high recurrence rate suggests that host factors may predispose to S. aureus catheter-related infections.

One-Port Laparoscopic Technique for Placement of Tenckhoff Peritoneal Dialysis Catheters: Report of Seventy-Nine Procedures

2008 ◽  
Vol 28 (6) ◽  
pp. 622-625 ◽  
Author(s):  
Hossein Ashegh ◽  
Jalal Rezaii ◽  
Khalil Esfandiari ◽  
Hassan Tavakoli ◽  
Mehdi Abouzari ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Rectus Sheath ◽  
Laparoscopic Technique ◽  
Exit Site ◽  
Exit Site Infection ◽  
Catheter Survival ◽  
Catheter Migration ◽  
Bacterial Peritonitis ◽  
Port Site Hernia

Background Laparoscopic techniques for placement of peritoneal dialysis catheters are becoming increasingly popular. In this paper, we report the results of one-port laparoscopic placement of Tenckhoff catheters in 79 patients in our center. Method Videoscopic monitoring was performed via a port inserted in the left upper quadrant and the catheter was placed via a pull-apart sheath through an incision near the umbilicus. The tip and the deep cuff of the catheter were placed into the true pelvis (on the urinary bladder) and into the rectus sheath respectively. A subcutaneous tunnel was created and a point midway on the umbilico-crestal line was selected as the exit site of the catheter. Catheters were capped for 2 weeks before initiation of peritoneal dialysis. Mean duration of the operation was 25 minutes. Results Four patients died during the follow-up period, all due to other medical problems, and 4 patients underwent renal transplantation. During a 48-month follow-up, catheter-related complications were catheter migration (1.3%; month 1), dialysate leakage (1.3%; month 1), port-site hernia (3.8%; after 6 months), exit-site infection (2.5%; months 1 and 9), and bacterial peritonitis (2.5%; after 6 months). Catheter survival was 97.2% in our series. Conclusion We obtained a low complication rate and a high catheter survival rate with this one-port laparoscopic technique.

Peritoneal Vicenza “Short” Catheter Outcomes and Comparison with International Society for Peritoneal Dialysis Guidelines

2021 ◽  
pp. 1-6
Author(s):  
Sabrina Milan Manani ◽  
Grazia Maria Virzì ◽  
Ilaria Tantillo ◽  
Anna Giuliani ◽  
Silvia Dian ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
International Society ◽  
Catheter Insertion ◽  
Complication Rates ◽  
Exit Site ◽  
Peritoneal Catheter ◽  
Visceral Injury ◽  
Catheter Survival ◽  
Tunnel Infection ◽  
Single Center Study

<b><i>Introduction:</i></b> A well-functioning peritoneal catheter is key to success of peritoneal dialysis (PD). The Vicenza “short” catheter is a modified Tenckhoff catheter with a shorter intraperitoneal segment. The aim of this study was to evaluate the incidence of catheter-related complications and catheter survival rate using the Vicenza “short” catheter, according to the goals suggested by the International Society for Peritoneal Dialysis (ISPD) guidelines. Second, we compared insertion techniques used in our center. <b><i>Methods:</i></b> This is a retrospective cohort, single-center study analyzing incident PD patients undergoing Vicenza “short” peritoneal catheter placement between January 1, 2015, and December 31, 2019. As clinical outcomes, we evaluated catheter patency at 12 months, exit-site/tunnel infection and peritonitis within 30 days of catheter insertion, visceral injury, or significant hemorrhage during the procedure, in accordance with ISPD guidelines. <b><i>Results:</i></b> The percentage of patency at 12 months for all catheter insertion methods was 88.91%, and the percentage for laparoscopic placement was 93.75%. The exit-site/tunnel infection and peritonitis occurring within 30 days of catheter insertion were, respectively, 0.75% and 2.2%; the visceral injury leading to intervention was 0.75%. We did not have any case of significant hemorrhage. All results were in line with ISPD guidelines. <b><i>Conclusion:</i></b> We conclude that the Vicenza “short” catheter is a suitable device for peritoneal access. The implantation procedure is safe and easy to perform, and both nephrologists and surgeons can do it. A confident use and a proper implantation of the Vicenza “short” catheter help achieve the clinical ISPD goals for the PD access procedure in terms of catheter survival and complication rates.

Clinical Outcomes of Immediate Full-Volume Exchange One Year after Peritoneal Catheter Implantation for CAPD

2000 ◽  
Vol 20 (2) ◽  
pp. 194-199 ◽  
Author(s):  
Joon Ho Song ◽  
Gyeong A. Kim ◽  
Seoung Woo Lee ◽  
Moon-Jae Kim
Keyword(s):  
Peritoneal Dialysis ◽  
University Hospital ◽  
Peritoneal Catheter ◽  
Exit Site Infection ◽  
Catheter Survival ◽  
Catheter Implantation ◽  
Group 2 ◽  
One Year ◽  
Full Volume ◽  
Group 1

Objective To evaluate actual risk of complications and 1-year catheter survival of immediate full-volume 2000-mL dialysate exchange after peritoneal catheter implantation. Design and Setting A prospective randomized comparative study in a university hospital kidney center. Patients The study included 59 end-stage renal disease patients entering into a continuous ambulatory peritoneal dialysis program between January 1996 and December 1997. Interventions In group 1 ( n = 21), exchange volume was gradually increased from 500 mL per 3 hours to full-volume exchange over 13 days. In group 2 ( n = 38), full-volume exchange per 6 hours was performed from the day of catheter implantation. Bed rest with minimal activity was recommended for the first 3 days in both groups. Main Outcome Measures Occurrence of catheter-related complications such as dialysate leakage, drainage failure, malposition, infectious complications, and, ultimately, catheter loss were observed for 1 year. Results After straight Tenckhoff catheter implantation, pericatheter dialysate leaks occurred in 9.5% of group 1 and in 10.5% of group 2 patients (no significance, NS). Within 1 month of implantation, the incidences of tunnel or exit-site infection, catheter malposition, and outflow failure were not significantly different between the two groups. Abdominal discomfort was noted in 2 patients from group 2. Peritonitis occurred in 9.5% and 5.3% (NS) within 2 weeks of catheter implantation, and in 14.3% and 10.5% (NS) after more than 2 weeks in group 1 and group 2, respectively. Early catheter loss within 1 month occurred in 4.8% of patients in group 1 and 5.3% in group 2 (NS). The causes of loss were persistent leakage in group 1, and persistent leakage combined with tunnel infection and outflow failure in group 2. The duration of hospitalization from the day of catheter insertion to discharge was definitely shorter in group 2 compared to group 1 (9.9 ± 0.6 days vs 15.0 ± 0.8 days, p < 0.001). For 1-year follow-up, the frequencies of peritonitis were 0.062 ± 0.015/patient-month in group 1 and 0.076 ± 0.018/patient-month in group 2 (NS). The actual 1-year catheter survival was 85.7% in group 1 and 84.2% in group 2 (NS). Conclusions One-year catheter survival after immediate full-volume peritoneal dialysis exchange was 84.2%. This study did not show any evidence that immediate full-volume exchange causes more short- or long-term complications compared to the stepwise volume increment method.

The Italian Registry of Pediatric Chronic Peritoneal Dialysis: A Ten-Year Experience with Chronic Peritoneal Dialysis Catheters

1998 ◽  
Vol 18 (1) ◽  
pp. 71-74 ◽  
Author(s):  
Stefano Rinaldi ◽  
Francesco Sera ◽  
Enrico Verrina ◽  
Alberto Edefonti ◽  
Francesco Perfumo ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Age Groups ◽  
Chronic Peritoneal Dialysis ◽  
Exit Site ◽  
Peritoneal Catheter ◽  
Entry Site ◽  
Bowel Infarction ◽  
Catheter Survival ◽  
Type Site ◽  
Catheter Infections

Objective To analyze the data from 347 peritoneal catheters implanted in 249 pediatric patients aged ≤ 15 years at start of chronic peritoneal dialysis (CPD). Design Restrospective study of the data collected between 1986 and 1995, in 20 dialysis centers, from the Italian Registry of Pediatric Chronic Peritoneal Dialysis. Data collection for each pediatric catheter included: catheter type, site and technique of insertion, complications, duration, and reason for removal or replacement. Results Fifty catheters were inserted in patients under 2 years of age, 50 in patients aged 2 5 years and 247 in patients over 5 years of age. Catheter types included 307 (88.5%) Tenckhoff (286 double cuff, 21 single cuff) and 40 (11.5%), double-cuff, Valli-type catheters. All catheters were surgically implanted and omentectomy was performed in 83.5% of cases; the entry-site was in the midline in 136 cases (39.2%) and paramedian in 211 (60.8%). During 6076 CPD months we observed 274 catheter related complications: 182 catheter infections (exit-site and/or tunnel infection), 23 leakages, 19 obstructions, 19 cuff-extrusions, 14 dislocations, 6 hemoperitoneum, 10 other (incidence of one complication every 21.8 dialysis months). A significant reduction of catheter-related complications occurred in the last five years, compared with the first 5 years. One hundred and six catheters were removed due to catheter-related causes: infection (83 cases), obstruction (11), dislocation (4), outer-cuff extrusion (3), leakage (2), bowel incarceration (2), and bowel infarction (1). Catheter survival was 72.2% at 12 months, 52.3% at 24 months, 32.8% at 36 months, and 25.7% at 48 months. Significantly lower catheter survival was found in younger children (0 2 years) compared with two other age groups (2 5 years, and > 5 years). No significant correlation was found between catheter survival and catheter entry-site (midline vs paramedian). Conclusions Catheter-related infections were confirmed to be the most common complication and most frequent cause of peritoneal catheter removal. In addition, catheter survival rate was worse in younger children, indicating that more effort should be made to improve peritoneal catheter survival particularly in this age group.

Modification of the percutaneous approach to peritoneal dialysis catheter placement under peritoneoscopic visualization: clinical results in 78 patients.

1992 ◽  
Vol 3 (1) ◽  
pp. 103-107
Author(s):  
N S Nahman ◽  
D F Middendorf ◽  
W H Bay ◽  
R McElligott ◽  
S Powell ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Catheter Placement ◽  
Seldinger Technique ◽  
First Episode ◽  
Dialysis Access ◽  
Peritoneal Dialysis Catheter ◽  
Exit Site ◽  
Exit Site Infection ◽  
Percutaneous Approach ◽  
Tunnel Infection

The placement of percutaneous peritoneal dialysis catheters under direct peritoneoscopic visualization is a relatively new technique for establishing peritoneal dialysis access. In this study, in which a modification of the Seldinger technique was used to facilitate the placement of the peritoneoscope, the experience with 82 consecutive catheterization procedures in 78 patients is reported. In 2 (2.4%) of 82 catheterization procedures, we were unable to enter the peritoneal cavity but experienced no other complications unique to the percutaneous approach. Of the 80 successful catheterization procedures, 76 represented first-time catheter placement and constituted a population subjected to life-table analysis examining catheter survival rates, the time to first cutaneous exit site or s.c. tunnel infection, and the time to first episode of peritonitis. After a follow-up period of 50.1 patient yr, 11 catheters were lost because of catheter dysfunction. Other clinical complications included peritoneal fluid leaks at the cutaneous exit site in 11 instances (0.22/patient yr), cutaneous exit site infection in 7 instances (0.14/patient yr), s.c. tunnel infection in 2 instances (0.04/patient yr), and 34 episodes of peritonitis (0.68/patient yr). The results of this study demonstrate that the suggested modification of the percutaneous placement of peritoneal dialysis catheters, under peritoneoscopic visualization, is a viable method for establishing peritoneal access.

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