Twardowski ZJ, Prowant BF, Pickett B, Nichols WK, Nolph KD,
Four-year experience with swan neck presternal peritoneal
Am J Kidney Dis
(Jan) 27:99-105 1996
In looking for suitable PD catheters we have reached the
point where "designer" catheters, or boutique items are appearing.
Such is the catheter described in the above article.
It is a standard silicone curled Tenckhoff catheter intraabdominally, joined
via a titanium connector to a long, subcutaneously tunneled
tubing. The latter exits the body on the chest wall lateral to the mid-
The preseternal catheter is meant for obese patients, patients with ostomies
patients who prefer a thoracic exit site for psychosocial(?) reasons.
This paper reports on the fate of 24 such presternal catheters compared to
fate of 47 swan-neck abdominal catheters. 36% of the presternal and 26% of
the abdominal catheters
patients were on APD; a possible source of error in evaluating infectious
complications. Catheter survival was comparable in the two groups as were
rates of infectious
complications. Much of the statistical evaluation is difficult to interpret,
as the assignment to an abdominal vs. presternal catheter was not randomized.
Thus, this remains primarily an initial, descriptive study.
Comment: Concerns of the reviewer are: (1) The need for special
device, and (2) potential difficulties in removal of an infected catheter
or management of tunnel infection. There is no cost comparison.
(Stephen I. Vas, M.D.,
Toronto, Ontario, CA)