Ten Years’ Experience with CAPD Catheters

Clinical practice guidelines for pediatric peritoneal dialysis

“…[20,24]. Both groups found no significant differences between the straight subcutaneous vs swan neck tunnel with regards to peritonitis rates or exitsite infections (opinion).…”

“…This is supported in pediatrics in a study by Lerner et al who found a significant difference in the risk of obstruction with a straight intraperitoneal segment versus the curled catheter (12 vs 6%, respectively, p<0.05) [19] (level IV). However, in a study by Sojo et al, they did not find any significant difference in the risk of tip migration or omental capture between the straight and curled intraperitoneal segments (944 catheter months at risk for the straight peritoneal segment vs 266 months at risk for the curled segment) [20] (III). Neither of these studies showed any difference in surgical revision rates or risk of peritonitis when comparing the two intraperitoneal catheter designs.…”

“…Both recommendations are based on the 1995 NAPRTCS annual report on PD and peritonitis outcomes [17] (level V). The evidence to support these recommendations is poor with most of the pediatric studies showing no difference in peritonitis, exitsite infection rates, or leaks between DCC and SCC [18][19][20] (levels III and V). Conversely there are three pediatric Table 1 Levels of grading of evidence [9] Levels of grading Description I Randomized, controlled trial (RCT) that demonstrates a statistically significant difference in at least one important outcome (i.e., survival, major illness); or if the difference is not statistically significant, a RCT of adequate sample size to exclude a 25% difference in relative risk with 80% power, given the observed results II A RCT that does not meet level I criteria III…”

“…A pediatric study by Sojo et al compared 85 Tenckhoff straight catheters with lateral exit sites to 33 Swan neck curled catheters with downward exit sites. They were unable to demonstrate any advantage of one exit-site orientation over the other in terms of rates of peritonitis, risk of exit-site or tunnel infection, or risk of leaking [20] (III). Adult studies, the best of which is only level IV, show little evidence to either support or refute the recommendation of downward oriented sites.…”

Peritoneal Access in Children

“…However, two pediatric series failed to demonstrate a significant reduction in infectious complications with the Swan-neck catheter as compared with straight catheters (21,22). A further pediatric series suggested a statistically nonsignificant reduction in the rate of ESI and peritonitis with double-cuff Swan-neck catheters (23).…”