Lower Malfunction Rate with Self-Locating Catheters

Abstract

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.

Prospective Randomized Study Comparing a Single-Cuff Self-Locating Catheter with a Single-Cuff Straight Tenckhoff Catheter in Peritoneal Dialysis

“…These data may be difficult to interpret as, in some cases, they describe complications (bleeding, leakage, ESI, peritonitis, hernias, or extrusion) that can be managed with peritoneal rest and conservative measures (15)(16)(17)22). Minguela et al removed 20 catheters (3 SLC/17 TC) and described other complications in a ratio of 40/18 (18). The most important article by Di Paolo et al describes 95 SLCs and 65 TCs with complications and 84/46 substitutions (19).…”

“…Some prospective studies (3)(4)(5)(6)(7)(8) show mixed results regarding catheter malfunction and survival when comparing catheters with a straight or spiral intraperitoneal segment or with any other device. At the time of writing this study, we were aware of only observational, nonrandomized studies that compare SLCs with CTs, generally double-cuff (15)(16)(17)(18)(19)(20)(21)(22).…”

“…The weight of the tip (12 g) is intended to prevent catheter displacement when floating in the peritoneal fluid or as a result of bowel loop movement. Although the incidence of malfunction with SLCs is lower when compared to other types of catheters, (14,(16)(17)(18)(19)(20)(21)(22)(23), current prospective studies are limited and there is no record of randomized studies.…”

Pre-clinical Evaluation of a Variable Length and Conforming Peritoneal Dialysis Catheter Weighted Anchor: In Vitro Analysis and Cadaver Feasibility Study

“…Multiple studies have shown improved function, decreased migration, and longer catheter survival with the SLPDC. [9][10][11][12][13][14] However, drawbacks of the SLPDC include the signi cantly increased diameter of the terminal tungsten cylinder compared to the nominal diameter of the catheter precluding the ability to place it percutaneously through small sheaths, its inability to vary the length of the effective catheter, and its restricted application to a straight catheter instead of a coiled catheter.…”

6. Type of peritoneal dialysis catheter

“…There was no significant difference in the annual peritonitis rate (self‐locating 0.72 ± 1.42, straight 0.95 ± 2.31, coiled 0.65 ± 0.86 episodes annually). There was better catheter survival in the self‐locating group at 1, 2 and 3 years than the coiled or straight groups, respectively (97%, 80%, 75% at 1 years and 96%, 80%, 67% at 3 years) 18 …”