Peritoneal dialysis catheter insertion

General remarks

• The incidence of peritonitis has been markedly reduced, mainly because of the new connection systems
• Therefore the focus of attention is perceived to be shifting from peritonitis reduction to preventing exit-site infections (ESI)
• Prevention of ESI has 3 prerequisites; optimal catheter design, appropriate implatation technique and post operative care
• The overall survival probability of swan neck missouri catheters at 36 months is double when compared to standard catheters
• Most common cathetes failures are due to obstruction, peritonitis, exit site infection, and leaks (cuff extrusion)
• Double-cuff catheters are preferred over single-cuff catheters
• PD catheters peritoneoscopically placed have less incidence of complications (infection, exit site leak) and longer catheter survival rates than those inserted surgically
  
  

Literature
1.Current trends in the use of peritoneal dialysis catheters. Negoi D, Prowant BF, Twardowski ZJ. Adv Perit Dial. 2006;22:147-52
2. Swan neck presternal ("bath tub") catheter for peritoneal dialysis. Twardowski ZJ, Nichols WK, Nolph KD, Khanna R. Adv Perit Dial. 1992;8:316-24
3. Design and testing of the Baxter Integrated Disconnect Systems (IDS).Balteau PR, Peluso FP, Coles GA, Michel C, Mignon FM, Tranaeus AP, Verger C, Zaruba K. Perit Dial Int. 1991;11(2):131-6
4. Long-term experience with Swan Neck Missouri catheters Twardowski ZJ, Prowant BF, Khanna R, Nichols WK, Nolph KD. ASAIO Trans. 1990 Jul-Sep;36(3):M491-4
5. Peritoneal dialysis catheter insertion. Asif A. Minerva Chir. 2005 Oct;60(5):417-28. Review