Rational Choice of Peritoneal Dialysis Catheter

Abstract

The peritoneal catheter should be a permanent and safe access to the peritoneal cavity. Catheter-related problems are often the cause of permanent transfer to hemodialysis (HD) in up to 20% of peritoneal dialysis (PD) patients; in some cases, these problems require a temporary period on HD. Advances in connectology have reduced the incidence of peritonitis, and so catheter-related complications during PD have become a major concern. In the last few years, novel techniques have emerged in the field of PD: new dialysis solutions, better connectology, and cyclers for automated PD. However, extracorporeal dialysis has continued to improve in terms of methods and patient survival, but PD has failed to do so. The main reason is that peritoneal access has remained problematical. The peritoneal catheter is the major obstacle to widespread use of PD. Overcoming catheter-related problems means giving a real chance to development of the peritoneal technique. Catheters should be as efficient, safe, and acceptable as possible. Since its introduction in the mid-1960s, the Tenckhoff catheter has not become obsolete: dozens of new models have been proposed, but none has significantly reduced the predominance of the first catheter. No convincing prospective data demonstrate the superiority of any peritoneal catheter, and so it seems that factors other than choice of catheter are what affect survival and complication rates. Efforts to improve peritoneal catheter survival and complication rates should probably focus on factors other than the choice of catheter. The present article provides an overview of the characteristics of the best-known peritoneal catheters.

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

“…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).…”

“…Different authors report global complications associated with the use of SLCs and TCs (15)(16)(17)(18)(19)22). 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 (19). In our study, 12 catheters were removed, only 2 due to malfunction in the TC group and none in the SLC group.…”

“…Literature is difficult to interpret with the data provided. The studies consulted (15)(16)(17)(18)(19)(20)(21)(22), do not mention the number of malfunctions for each type of catheter (SLC or TC), nor the procedures used to solve them, except, in some cases, catheter removal. De Toro et al It was observed that the groups of SLCs described by these authors were sometimes disproportionally higher.…”

“…Clinical experience shows that Tenckhoff catheters (TCs) are the most commonly used internationally, with several variations of both subcutaneous and intra-abdominal segments to prevent displacement (9)(10)(11)(12). Self-locating catheters (SLCs) are similar to TCs, but the end of the catheter is heavier and includes a small tungsten cylinder at the distal end (13,15). 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.…”

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

“…Various PD catheters have been designed to improve access to the peritoneal cavity, resulting in an ongoing debate regarding the most appropriate catheter (3,4). Polyethylene and nylon catheters became commercially available in the 1950s, when intermittent PD was established (1).…”