Comparative Analysis of Two-Piece Extended Peritoneal Dialysis Catheters with Remote Exit-Site Locations and Conventional Abdominal Catheters

2010 ◽  
Vol 30 (1) ◽  
pp. 46-55 ◽  
Author(s):  
John H. Crabtree ◽  
Raoul J. Burchette
Keyword(s):  
Poisson Regression ◽  
Coagulase Negative Staphylococcus ◽  
Site Location ◽  
Exit Site ◽  
Exit Site Infection ◽  
Catheter Survival ◽  
Patient Demographics ◽  
Kaplan Meier ◽  
Included Patient ◽  
Upper Abdomen

BackgroundAn alternative peritoneal catheter exit-site location is sometimes needed in patients with obesity, floppy skin folds, intestinal stomas, urinary and fecal incontinence, and chronic yeast intertrigo. Two-piece extended catheters permit remote exit-site locations away from problematic abdominal conditions.ObjectiveThe effect on clinical outcomes by remotely locating catheter exit sites to the upper abdomen or chest was compared to conventional lower abdominal sites.MethodsIn a nonrandomized design, peritoneal access was established with 158 extended catheters and 270 conventional catheters based upon body habitus and special clinical needs. Prospective data collection included patient demographics, infectious and mechanical complications, and catheter survival.ResultsKaplan–Meier survival time until first exit-site infection was longer for extended catheters ( p = 0.03). Poisson regression showed no difference in exit site, subcutaneous tunnel, and peritonitis infection rates; however, the proportion of catheters lost during peritonitis episodes was significantly greater for extended catheters ( p = 0.007) and appeared to be due primarily to coagulase-negative staphylococcus organisms. Poisson regression showed interactions of body mass index (BMI) and diabetic status in determining catheter loss from peritonitis for both catheter types ( p = 0.02). Extended catheter patients had higher BMI and diabetes prevalence ( p < 0.0001). Overall extended catheter survival at 1, 2, and 3 years (92%, 80%, 71%) trended lower than conventional devices (93%, 87%, 80%; p = 0.0505).ConclusionsExtended catheters enable peritoneal access for patients in whom conventional catheter placement would be difficult or impossible. Certain patient and extended-catheter characteristics may contribute to loss from peritonitis.

Peritoneal Dialysis Cuff-Shaving—A Salvage Therapy for Refractory Exit-Site Infections

2019 ◽  
Vol 39 (3) ◽  
pp. 276-281 ◽  
Author(s):  
Catarina Meng ◽  
Ana Beco ◽  
Ana Oliveira ◽  
Luciano Pereira ◽  
Manuel Pestana
Keyword(s):  
Peritoneal Dialysis ◽  
Rescue Therapy ◽  
Significant Proportion ◽  
Purulent Discharge ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Catheter Survival ◽  
Kaplan Meier ◽  
Dialysis Vintage

Introduction Cuff-shaving has been described as a salvage technique for refractory exit-site infections, with conflicting data regarding infection and catheter outcomes. We describe our experience with cuff-shaving as a rescue therapy for exit-site infections unresponsive to systemic therapy. Methods We retrospectively reviewed patients who underwent cuff-shaving between January 2012 and June 2017. Refractory exit-site infection was defined as purulent discharge from the exit site with no clinical response after 3 weeks of systemic antibiotic treatment. Results Fifty-three cuff-shavings were included, mean age was 53.4 ± 13.4 years, 26 patients were male. Median dialysis vintage was 29 months (interquartile range [IQR] 14.3 – 38), and 39 (73.6%) were on continuous ambulatory peritoneal dialysis (CAPD). The exit-site infection rate before cuff-shaving was 1.12 episodes per patient-year and the median time from infection to shaving was 52 days (IQR 35 – 76). The most frequent agents were Staphylococcus aureus (34%), Corynebacterium spp. (17%) and Pseudomonas aeruginosa (15%). Median follow-up was 9 months (IQR 1 – 18.5), during which time 35 catheters were removed, 5 due to non-infectious reasons. Using the Kaplan-Meier survival analysis, median catheter survival was 24 months (95% confidence interval [CI] 4.17 – 43.83). At 12 months, the probability of catheter survival was 54% and was not statistically different between gram-positive and gram-negative agents, although it was significantly shorter for fungal agents. Conclusion Cuff-shaving is a feasible rescue therapy to treat refractory exit-site infections. In our experience, it allowed resolution of infections in a significant proportion of cases, except for fungal agents, and therefore extended catheter survival time, besides being associated with a small rate of complications.

Lower Malfunction Rate with Self-Locating Catheters

2001 ◽  
Vol 21 (3_suppl) ◽  
pp. 209-212 ◽  
Author(s):  
Ignacio Minguela ◽  
Manuel Lanuza ◽  
Ramón Ruiz De Gauna ◽  
Raquél Rodado ◽  
Soledad Alegría ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
T Test ◽  
Catheter Removal ◽  
Control Group ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Catheter Survival ◽  
Tenckhoff Catheter ◽  
Kaplan Meier

Objective We analyzed malfunction rates (obstruction, omental wrapping, displacement) and catheter survival for self-locating catheters as compared with other Tenckhoff catheter designs. Patients and Methods We conducted our survey at two centers, prospectively studying all self-locating catheters implanted from May 1997 to October 2000 and used for peritoneal dialysis (PD). Tenckhoff catheters of other designs used previously in our units were used as the control group. We analyzed removal causes and catheter survival. Results We studied 173 catheters (105 self-locating catheters, 53 straight catheters, and 15 coiled catheters) implanted in 139 patients (43% of them women) with a mean age of 53 ± 14 years. The analysis of catheter removal showed that 3 of 105 self-locating catheters, 3 of 15 coiled catheters, and 17 of 53 straight catheters were removed owing to malfunction (c 2: p = 0.0000). Kaplan–Meier curves showed that the bulk of removals for malfunction occurred within the first 3 months after PD start. The group of self-locating catheters showed better survival (log-rank: p = 0.0009). Other causes for catheter removal included peritonitis ( n = 22), exit-site infection alone ( n = 4), and end of PD treatment ( n = 66). No significant differences were seen in the annual peritonitis rate (straight-tip: 0.955 ± 2.315 episodes annually; coiled-tip: 0.651 ± 0.864 episodes annually; self-locating: 0.720 ± 1.417 episodes annually; t-test: p > 0.400). No gut or bladder perforations were observed. Conclusion In our survey, self-locating catheters were associated with better survival and fewer removals for malfunction than were Tenckhoff catheters of other designs.

The Efficacy of Silver-Ion Implanted Catheters in Reducing Peritoneal Dialysis-Related Infections

2003 ◽  
Vol 23 (4) ◽  
pp. 368-374 ◽  
Author(s):  
John H. Crabtree ◽  
Raoul J. Burchette ◽  
Rukhsana A. Siddiqi ◽  
Isan T. Huen ◽  
Linda L Hadnott ◽  
...  
Keyword(s):  
Ion Beam ◽  
Controlled Trial ◽  
Silver Ion ◽  
Control Group ◽  
Site Infection ◽  
Control Groups ◽  
Exit Site ◽  
Exit Site Infection ◽  
Catheter Survival ◽  
And Control

♦ Background Dialysis-related infections are the commonest cause of catheter loss and transfer to hemodialysis. Surface modifications of the catheter that reduce infections are of major importance. ♦ Objective The efficacy of silver-ion treated catheters in reducing dialysis-related infections was tested. ♦ Methods The study design was a prospective, randomized controlled trial. Patients were implanted with either a silver-treated study catheter or a control catheter. Prospective collection of data included infectious complications and catheter survival. ♦ Results The subject groups were comprised of 67 silver-treated catheters and 72 control catheters. Demographic characteristics of the study and control groups were equal. Exit-site infection rates for the study group and control group (0.52 and 0.45 episodes/patient-year of dialysis respectively) were not different by Poisson regression analysis ( p > 0.4). Peritonitis rates were identical for the two groups (0.37 episodes/patient-year) and were not different by Poisson analysis ( p > 0.9). Antibiotic-free intervals between infections for the study and control groups were not significantly different for exit-site infections ( p = 0.58), peritonitis ( p = 0.44), or both infections combined ( p = 0.47). Actuarial analyses showed no differences between the groups in the probability of remaining free of exit-site infection ( p> 0.2) or peritonitis ( p > 0.7). Similarly, catheter survival was not significantly different between the groups ( p > 0.6). ♦ Conclusion Surface modification of catheters with ion beam implantation of silver produced no clinical effect with respect to reducing dialysis-related infections.

scholarly journals Selective Infracolic Omentecomy and Fixation Reduces Complications after Laparoscopic Assisted Peritoneal Dialysis Catheter Placement

2018 ◽  
Vol I (1) ◽  
pp. 06-11
Author(s):  
Andries Ryckx
Keyword(s):  
Peritoneal Dialysis ◽  
Catheter Placement ◽  
P Value ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Exit Site ◽  
Exit Site Infection ◽  
Catheter Survival ◽  
Catheter Obstruction ◽  
Infracolic Omentectomy

Introduction Peritoneal dialysis (PD) as a treatment for patients with end-stage renal disease (ESRD) provides a competitive alternative to hemodialysis (HD). Long-term catheter survival remains challenging and techniques are not standardized. Advanced laparoscopic placement with fixation and omentectomy might increase catheter survival. The goal of our study was to evaluate if selective infracolic omentectomy and fixation reduced complications after CAPD catheter placement. Materials and Methods A prospective database of patients with CAPD catheter placement from March 2004 to March 2015 was analyzed. All procedures were performed laparoscopically assisted and under general anesthesia by a single surgeon. 78 patients were included, there were no exclusion criteria. Statistical analysis was performed with SPSS. Fisher exact test and log-rank test with calculation of P-value was executed. P-value of <0.05 was considered significant. Results Of the 78 patients who underwent catheter placement, 53 (68%) were males and 25 (32%) were females. The mean age was 54 (ranged from 13 to 88 years). Selective infracolic omentectomy was performed in 32 patients if the momentum reached beyond the promontory. Non-resorbable sutures to fix the catheter were applied in 33 patients. The average duration of peritoneal dialysis was 21 months (range from ten days to 84 months). Omentectomy significantly reduced the incidence of catheter obstruction (3 vs. 11%, P=0.028) but not of catheter dislocation (19 vs. 30%, P=0.101). Omentectomy did not significantly increase the incidence of peritonitis (22 vs. 31%,P=0.133) or exit-site infection (16vs 17%, P=0.238). Catheter fixation with non-resorbable sutures reduced catheter dislocation (21 vs. 23%, P=0.226) and catheter obstruction( 12 vs.17%,P=0.223) with a significant reduction of peritonitis (15 vs. 29%, P=0.044) and no effect on exit-site infection (15 vs. 17%,P=0.251). Conclusion Laparoscopic PD catheter placement with selective omentectomy and fixation of the catheter to the abdominal wall is safe and feasible and leads to fewer complications. Key words: peritoneal, dialysis, catheter, complications, laparoscopy, omentectomy.

Exit-Site Infection in Continuous Ambulatory Peritoneal Dialysis: A Review

1991 ◽  
Vol 11 (4) ◽  
pp. 333-340 ◽  
Author(s):  
Mary Anne Luzar
Keyword(s):  
Healing Process ◽  
Nasal Carriage ◽  
Epidemiological Studies ◽  
Future Research ◽  
Site Infection ◽  
Exit Site ◽  
Term Care ◽  
Exit Site Infection ◽  
Nasal Carrier ◽  
Catheter Survival

Although the ability of CAPD to successfully treat end-stage renal disease is now well established, exitsite infection (ESI) remains a serious cause of morbidity. The objective of this article is to review recent advancements relating to ESI pathogenesis and its reduction. Current definitions of ESI are reviewed, as are comparative studies of etiology. Emphasis is placed on the literature identifying Staphylococcus aureus as the primary cause of ESI in CAPD. The article reviews reported rates of ESI and discusses reasons for variations of this complication's reported frequency. The selection of catheters available in CAPD are discussed, as are studies demonstrating the threat of S. aureus to catheter survival. The pathogenesis of exit-site infection related to S. aureus nasal carriage in CAPD is reviewed in light of recent findings indicating the pre-CAPD nasal carrier as the patient at risk for subsequent ESI. Postoperative and long-term care of the catheter patient are reviewed for various literature protocols. Treatment recommendations for choice of agents are discussed. Future research should include a better understanding of the morphology of the CAPD catheter exit-site in humans and the healing process. ESI epidemiological studies should be encouraged in tandem with well -designed, controlled studies on the value of prophylactic treatment.

Experience with the Toronto Western Hospital Permanent Peritoneal Catheter

1984 ◽  
Vol 4 (2) ◽  
pp. 95-98 ◽  
Author(s):  
Ramesh Khanna ◽  
Sharron Izatt ◽  
Debby Burke ◽  
Raymond Mathews ◽  
Stephen Vas ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Exit Site ◽  
Peritoneal Catheter ◽  
Toronto Western Hospital ◽  
Exit Site Infection ◽  
Catheter Survival ◽  
Tenckhoff Catheter ◽  
Western Hospital ◽  
Catheter Tip ◽  
Catheter Failure

Prospective controlled trial with Tenckhoff, Toronto Western Hospital and Goldberg catheter showed a lower incidence of catheter-tip dislodgement from the pelvis with the Toronto Western Hospital catheter. A 1982 retrospective review of experiences, revealed significantly better one and two year catheter survival with the Toronto Western Hospital catheter #2 compared to the straight Tenckhoff catheter inserted at the bed side but not compared to the surgically inserted Tenckhoff catheter. Early dialysate leak was a significant compilation observed with the use of all catheters. Lateral placement of catheters has practically eliminated this complication. Catheter exit site infection now is the major cause of catheter failure.

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.

Prospective Comparison of Downward and Lateral Peritoneal Dialysis Catheter Tunnel-Tract and Exit-Site Directions

2006 ◽  
Vol 26 (6) ◽  
pp. 677-683 ◽  
Author(s):  
John H. Crabtree ◽  
Raoul J. Burchette
Keyword(s):  
Peritoneal Dialysis ◽  
Dialysis Access ◽  
Peritoneal Dialysis Catheter ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Mechanical Complications ◽  
Tunnel Infection ◽  
Kaplan Meier ◽  
Lateral Tunnel

Objective Guidelines for optimal peritoneal dialysis access support both downward and lateral exit-site directions. Numerous clinical reports support the superiority of downward exit sites but none substantiate lateral configurations. Methods This prospective study compared infectious and mechanical complications between 85 catheters with a preformed arcuate bend to produce a downward exit site and 93 catheters with a straight intercuff segment configured to create a lateral exit site. Results Kaplan–Meier survivals were not different for time to first exit-site infection ( p = 0.62), tunnel infection ( p = 0.89), or peritonitis ( p = 0.38) for downward and lateral exit-site directions. Poisson regression showed no differences in rates (episodes/patient-year) of exit-site infection (0.26 vs 0.27, p = 0.86), tunnel infection (0.02 vs 0.03, p = 0.79), peritonitis (0.42 vs 0.43, p = 0.87), or catheter loss (0.06 vs 0.09, p = 0.29) for downward and lateral exit sites. Kaplan–Meier analyses of antibiotic-free intervals for exit-site ( p = 0.94) and peritonitis infections ( p = 0.72) were not different for the two groups. There was one case of catheter tip displacement with flow dysfunction in each group. There were no pericatheter hernias or spontaneous cuff extrusions. Catheter survival between groups was not different ( p = 0.20). Conclusions Catheter types employing downward and lateral tunnel-tract and exit-site configurations produce equivalent outcomes for infectious and mechanical complications.

Finding the Right Position: A Three-Year, Single-Center Experience with the “Self-Locating” Catheter

2010 ◽  
Vol 30 (5) ◽  
pp. 519-523 ◽  
Author(s):  
Brigitte Bergamin ◽  
Oliver Senn ◽  
Alf Corsenca ◽  
Philipp Dutkowski ◽  
Markus Weber ◽  
...  
Keyword(s):  
Observation Time ◽  
The Self ◽  
Exit Site ◽  
Exit Site Infection ◽  
Improve Outcome ◽  
Catheter Survival ◽  
Catheter Migration ◽  
Single Center Experience ◽  
Catheter Failure ◽  
The Right

BackgroundPeritoneal dialysis (PD) catheter displacement is a major cause of dysfunction. Various catheter forms have been designed to improve outcome. One of them is based on the classical Tenckhoff catheter, but includes a small tungsten cylinder at the distal end to optimize location and to prevent dislocations.MethodsIn this retrospective study, we analyzed the functionality and complication profile of the self-locating catheter implanted at our center from November 2005 to September 2008 in our PD program.ResultsData from 27 self-locating catheters implanted in 25 patients (12 women) were obtained. Patients were followed for up to 30 months (median observation time: 13 months), resulting in a cumulative study period of 357 PD months. A total of 22 complications were identified, including 1 episode of peritonitis per 52 patient–months, 1 tunnel infection, and 1 exit-site infection. The “functional catheter failure incidence rate” was approximately 0.01 catheters per month on PD (or approximately 1 catheter loss per 100 PD months). The catheter survival was 93% at 1 year.ConclusionsThe “self-locating” PD catheter demonstrates low rates of catheter migration and dislocations, and good catheter survival.

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