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Article Review/Hyperlink |
Twardowski ZJ, Prowant BF, Pickett B, Nichols WK, Nolph KD, Khanna R
Four-year experience with swan neck presternal peritoneal dialysis catheter
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- sternum. The preseternal catheter is meant for obese patients, patients with ostomies and for patients who prefer a thoracic exit site for psychosocial(?) reasons.
This paper reports on the fate of 24 such presternal catheters compared to the 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 tunneling 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)
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