The “Ronco” Catheter for Continuous Flow Peritoneal Dialysis

Abstract

To perform CFPD, a two way access must be available in order to allow continuous inflow and outflow of the solution. This is most likely achieved with a double lumen peritoneal catheter. To design a double lumen catheter does not necessarily mean to increase the size of the tube or to increase the discomfort of the patient. However, the real challenge is to find a design in which minimal re-circulation is experienced. The two tips of the catheter must be positioned such that a maximal exposure of the peritoneal surface to the fluid is guaranteed during one single passage of the fluid from one lumen to another. Double lumen catheters with one short branch and another long of straight and of spiral shape were originally designed. Ash and coworkers have designed a catheter with a t-shape configuration in order to distantiate to the maximum the tips of the two lumens. Recently we have designed a novel catheter for CFPD equipped with a thin walled silicone diffuser used to gently diffuse the inflow dialysate into the peritoneum. The holes on the round tapered diffuser are positioned to allow dialysate to perpendicularly exit 360 degrees from the diffuser. The diffuser design and hole locations disperse the high-flow dialysate fluid at 360 degrees, reducing trauma to the peritoneal walls and allowing the dialysate to mix into the peritoneum. The dispersed fluid infused into the peritoneal cavity is then drained through the second lumen whose tip is placed into the lower Douglas cavity. The new catheter with diffuser is also equipped with a special removable hub that allows for easy creation of the subcutaneous tunnel without increasing the size of the skin exit site. The results so far achieved seems to offer advantages in terms of high flows, minimal pressure regimes and negligible recirculation.

Peritoneal Dialysis in Acute Kidney Injury: Lessons Learned and Applied

“…External regeneration of dialysate by sorbents or hemodialysis (HD) may be employed, making the technique more viable (15,46,47). Recent improvements to potentially increase the utilization of CFPD are the development of new dual lumen catheters designed to minimize recirculation (48) and the use of segmental bioimpedance analysis (49) to measure intraperitoneal volume, assessing the ultrafiltration volume in real time.…”

Peritoneal Dialysis for Acute Kidney Injury: Techniques and Dose

“…A large volume of dialysate is necessary for CFPD unless it is recirculated or regenerated using a combination of fi ltrative and sorbent technologies. 2 separate catheters are required as originally described, although a dual lumen catheter designed to minimize recirculation is available [13]. Ultrafi ltration control remains a problem.…”

Continuous Flow Peritoneal Dialysis

“…With two catheters, average urea clearances of 44 to 58 ml/min have been achieved (14,22,29) versus 14 to 20 ml/min with double lumen catheters (17,32). Recently Ronco et al (21,33) developed a new type of double lumen catheter with a diffuser to maximize mixing, whereby higher clearances can be achieved. In this study, we used the CFPD technique with two separate catheters instead of one double lumen catheter, because of the abovementioned better results and for the practical reason that the available double lumen catheters have to be placed surgically and are not available in pediatric sizes.…”