Four-year experience with swan neck presternal peritoneal dialysis catheter

Twardowski, Zbylut J.; Prowant, Barbara F.; Pickett, Barbara; Nichols, W. Kirt; Nolph, Karl D.; Khanna, Ramesh

doi:10.1016/s0272-6386(96)90036-0

Cited by 39 publications

(34 citation statements)

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“…30 No signifi cant difference in risk of peritonitis has been observed with the design of catheters, surgical techniques used to place the catheters (laparoscopic versus open surgical), or location of catheter exit sites (pre-sternal or abdominal). 31,32 Quality improvement initiatives in PD, using a comprehensive approach that includes use of prophylactic antibiotics for peritonitis, exit site and catheter care, and training and retraining of patients can go long way in having positive effects on reducing rates of peritonitis and exitsite infection. PD outcomes can be further improved by implementation of continuous quality improvement (CQI) programs to track the root cause of peritonitis as well as rates of exit-site infection, peritonitis, and technique failure by careful data collection and providing feedback to the PD team so that appropriate interventions can be implemented.…”

Section: Growing a Pd Programmentioning

confidence: 99%

Growing a peritoneal dialysis program: A single‐center experience

Saxena

2011

Dialysis & Transplantation

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Section: Growing a Pd Programmentioning

confidence: 99%

Growing a peritoneal dialysis program: A single‐center experience

Saxena

2011

Dialysis & Transplantation

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“…Graduate School of Medicine, The University of Tokyo 3 Department of Urology Tokyo, Japan *email: okposi@hotmail.co.jp…”

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confidence: 99%

Successful Management of a Chest Exit Site in a Psoriasis Patient

et al. 2015

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Editor:Clinical guidelines recommend the use of an appropriate length of catheter for exit sites in peritoneal dialysis (PD) (1). Although exit sites are generally located on the abdomen, this location is not preferable when patients are obese or have intestinal stomas, skin folds, or particular body shapes. In such cases, an exit site is created on the upper abdomen or chest. To our knowledge, no case of modification of an exit site due to skin disease has previously been reported. We report the first case of a patient with an exit site located on the chest instead of the abdomen because of plaques of psoriasis on the abdomen. We also report that the patient was free of psoriatic exacerbation of the skin and catheter obstruction for 2.5 years.A 71-year-old Japanese man with end-stage renal disease attributed to hypertensive nephrosclerosis began hemodialysis (HD) in 2002 and soon switched to PD. In 2007 and 2009, he was diagnosed with peritonitis and returned to HD. He subsequently requested a third course of PD because he was keen to continue his job; he was therefore admitted to our hospital. The patient had a history of psoriasis (from the age of 67 years), and had regularly attended the department of dermatology to undergo topical treatments. Upon admission, he had scaly erythematous plaques of psoriasis on his abdomen, back, buttock, and extremities but, fortunately, the skin on his chest was unaffected. We therefore planned to create an exit site on the right side of the chest where psoriatic plaques were absent. Upon surgical insertion of the Tenckhoff catheter, we constructed a long (30 cm) subcutaneous catheter tunnel in a straight line from the exit of the abdominal cavity to the exit site on the right-hand side of the chest (Figure 1). We extended the catheter by connecting two catheters with titanium connectors as described previously (2). We inserted the extended catheter, creating a long subcutaneous tunnel without bleeding, obstruction, leaking, or impaired drainage. His psoriatic activity remained stable during the perioperative period. One year later, he had peritonitis, but this was caused by a defective device rather than any technique failure. He restarted PD treatment and currently remains in a stable condition, having undergone a further 1.5 years of treatment without any problems.Access via a chest exit site was introduced in 1992 by Twardowski (3). Because our patient had active eruptions on the abdomen, we chose the chest as the appropriate exit site (4). Psoriasis is a chronic inflammatory skin disease manifested as raised, erythematous plaques with adherent scales. The infiltration of inflammatory cells causes thickening of the epidermis. We considered the thickened, fragile skin of this patient as inappropriate for the surgery. Moreover, our patient was prescribed steroid treatment for psoriasis, which we recognized as conveying a potential infection risk that we needed to avoid.In summary, we successfully managed an exit site located on the chest in a psoriasis patient without any e...

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“…Compared with facility-based hemodialysis (FhD), home-based renal replacement therapies (RRTs), including peritoneal dialysis (PD) and home hemodialysis (hhD), are more cost effective, might be associated with improved patient satisfaction, and are associated with similar-if not better-outcomes for patients with end-stage renal disease (1)(2)(3)(4). Despite those benefits, PD and hhD are both used in less than 10% of the world's prevalent dialysis population (5,6).…”

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confidence: 99%

“…Despite those benefits, PD and hhD are both used in less than 10% of the world's prevalent dialysis population (5,6). The underutilization of these therapies is connected to several barriers to home-based, self-care therapy.…”

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confidence: 99%