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Query: UMLS:C0031154 (peritonitis)
 15,372 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a retrospective study over three years, 23 patients were provided with a swan-neck Tenckhoff catheter (SNC) and 49 patients (control group) with a straight Tenckhoff catheter (STC) at the beginning of CAPD and were observed over a follow-up period of 608 patient-months. The aim of the study was to examine the reduction of complications in the course of CAPD with SNC resulting from technical causes, such as catheter dislocations, infections at the catheter's point of exit, the tunnel and the peritoneum. The causes of renal insufficiency, the reasons for choosing CAPD as a dialytic procedure, the causes of catheter loss as well as the frequency of infections associated with CAPD were analyzed. The main reasons for catheter loss were peritonitis and dislocations. In the SNC group a significant reduction of dislocations to 8.7% was observed as against 26.5% with STC. On the other hand, with SNC significantly more cases of peritonitis were observed in terms of statistics, with 1.1 episodes per patient-year (EOP/PY) compared with 0.3 EOP/PY with STC. The frequency of the exit site and tunnel infections and the cumulative survival probability of the catheters did not differ. The SNC is an interesting alternative to the STC; however, the expectations were only partly met.
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PMID:Three years of experience with the swan-neck Tenckhoff catheter. 168 Apr 27

Since the introduction of disconnect systems, a marked reduction in continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis has been reported in the literature. At our centre too, a highly significant decline in the peritonitis rate was observed after the introduction of the Twin bag in 1990. In a multivariate analysis which we published recently, the Twin bag system, in conjunction with the more frequent use of the swan neck catheter, correlated significantly (p < 0.001) with an increase in the peritonitis-free interval. In the present study we retrospectively analyzed the bacteriological cultures of the peritonitis episodes, the antibiotic treatment prescribed, and the number of hospitalization days (HDs) before (non-Twin bag group; NTG) and after the introduction of the Twin bag system in our centre (Twin bag group; TG). In terms of absolute numbers, the decreased incidence of peritonitis in the TG was due by and large to a decline in all pathogenic micro-organisms, but mostly to a reduction of coagulase-negative staphylococci (CNS) compared with the NTG. The incidence of culture-negative episodes, however, showed no difference between the two groups. Proportionally, there was a significant increase in culture-negative peritonitis in the TG, whereas infections caused by CNS significantly decreased in comparison with the NTG (p < 0.01). The pattern of the antibiotics prescribed, i.e. mono- versus multi-drug regimens, did not differ between the two groups. Since, of all micro-organisms involved, CNS infections showed the largest decline in absolute numbers. Staphylococcus aureus increased relatively (43%) after the introduction of the Twin bag system.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Bacterial and clinical sequelae of the Twin bag system in continuous ambulatory peritoneal dialysis. A single centre study. 805 41

Since 15 December 1991 four swan neck presternal catheters (SNPC) have been implanted in four children aged 2-11 years. The observation period ranged from 4 to 10 months. The aim of this study was to evaluate the usefulness of a new peritoneal dialysis catheter implantation method in paediatric patients. The indications for insertion of the SNPC were: young age, use of nappies, obesity and recurrent exit site infection (ESI). The surgical technique of the SNPC implantation was similar to that used for adults. The chest location of the catheter exist site is advantageous for the following reasons: (1) easier care of a small child because of greater distance from nappies, (2) better healing and decreased risk of ESI in the area with less fat thickness and (3) less trauma. A larger number of children with a longer follow-up is necessary for better evaluation of the SNPC, as well as for estimation of frequency of ESI and peritonitis.
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PMID:Swan neck presternal catheter for continuous ambulatory peritoneal dialysis in children. 825 22

A permanent bowing of the subcutaneous part of the Tenckhoff-type catheter (bent neck--Quinton, and swan neck--Accurate Surgical Instruments) enables the catheter to turn from an upward direction of the subcutaneous tunnel to a downward direction by a smooth 160 degrees-180 degrees bend creating a downward skin exit. We have used this catheter shape in combination with a coiled intra-abdominal edge. Two sizes are available for children. We use 2 cuffs and glue them ourselves according to the body size. In this study we compare the durability of the traditional subcutaneously straight catheter in 8 children aged 0.1-12.6 years (Group A) with the bent shaped catheter in 8 children aged 3.7-15.8 years (Group B). Median duration of function was 10.5 (2-34) and 8 (3-36) months, respectively. Frequency of complications was equal in both groups: peritonitis episodes 0.69/year in Group A and 0.53/year in Group B; tunnel infection 0.16 vs 0.11/year; skin exit infection 0.54 vs 0.53/year; noninfectious complications 0.16 vs 0.32/year; mean number of catheters used was 1.0 vs 1.1/treatment year. Treatment had to be terminated in some patients: kidney transplantation 5, kidney recovery 1, severe peritonitis 1. The bent subcutaneous catheter shape did not show any medical or technical disadvantage compared with the straight type, but the downward directed catheter skin exit can be covered invisibly under bikini or bermuda shorts which means aesthetic and social advantage. Whether the downward drainage of secretes and cell detritus influences the rate of tunnel infection positively cannot be answered to date.
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PMID:Bent subcutaneous peritoneal catheter shape for regular dialysis treatment in children. 839 84

The swan neck presternal catheter is composed of two flexible (silicon rubber) tubes joined by a titanium connector at the time of implantation. The exit site is located in the presternal or parasternal area. The catheter located on the chest was designed to reduce the incidence of exit site infections compared with peritoneal dialysis catheters with abdominal exit sites. From August 1991 to May 1995, 24 swan neck presternal catheters have been implanted in 24 patients for the following reasons: obesity nine patients, ostomies three patients, a suprapubic catheter one patient, previous problems with abdominal catheters two patients, desire to use a bathtub five patients, need to use a whirlpool one patient, need to wear sweatpants with an elastic waistband one patient, and body image two patients. In the same period, 47 abdominal swan neck catheters were implanted in 44 patients who preferred catheters with the exit on the abdomen. Presternal catheters tended to perform better regarding exit and tunnel infections, even though they were implanted in several patients in whom regular catheters with the exit on the abdomen would be difficult or impossible to implant. Two-year survival probability of presternal catheters was 0.88 +/- 0.14 (+/- SE). Recurrent/refractory peritonitis was the only reason of catheter failure. The differences in results between presternal and abdominal catheters were statistically insignificant; only the use of antibiotics to treat exit site infection was significantly higher with abdominal catheters. Patient acceptance of the exit position was good; at least seven patients preferred presternal catheter for psychological or body image reasons. We conclude that the swan neck presternal catheters provide excellent results comparable to those achieved with swan neck abdominal catheters. The catheter seems suitable for any patient commencing peritoneal dialysis and is particularly useful in extremely obese patients (body mass index > 40 kg/m2) and those with ostomies. The catheter exit location in the chest may be preferred by some patients, both men and women, for psychological or body image reasons. No specific contraindications to the presternal catheter implantation have been identified.
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PMID:Four-year experience with swan neck presternal peritoneal dialysis catheter. 854 44

The most commonly used technique for insertion of peritoneal dialysis (PD) catheters is open surgical approach by minilaparotomy. Percutaneous implantation via the peritoneoscopic technique is expanding. Studies have suggested that PD catheters placed peritoneoscopically have longer survival rate than surgically placed ones. However, these studies were not randomized, where the surgical group had more patients who were obese or had prior abdominal surgery, and therefore, the selection of patients may have biased the results. We conducted a prospective randomized study in which patients underwent PD catheter placement by either the surgical or the peritoneoscopic technique. In the period from October 1992 through October 1995, 148 double-cuff, curled-end, swan-neck PD catheters were placed in 148 patients. The outcome of the 76 patients in whom the PD catheters were placed peritoneoscopically was compared with that of the 72 patients in whom the catheters were placed surgically. Early peritonitis episodes (within 2 weeks of catheter placement) occurred in 9 of 72 patients (12.5%) in the surgical group, versus 2 of 76 patients (2.6%) in the peritoneoscopy group (P = 0.02). This higher rate of infection was most likely related to a higher exit site leak in the surgical group (11.1%) as compared with the peritoneoscopy group (1.3%). Moreover, peritoneoscopically placed catheters were found to have better survival (77.5% at 12 months, 63% at 24 months, and 51.3% at 36 months) than those placed surgically (62.5% at 12 months, 41.5% at 24 months, and 36% at 36 months) with P = 0.02, 0.01, and 0.04, respectively. We conclude that peritoneoscopically placed PD catheters have a longer survival rate than surgically placed ones. Furthermore, the rate of exit site leak and early infection is lower in the peritoneoscopic method.
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PMID:Peritoneoscopic versus surgical placement of peritoneal dialysis catheters: a prospective randomized study on outcome. 991 76

Peritoneal dialysis (PD) catheter migration to the upper abdomen is not an uncommon cause of catheter failure. We prospectively examined the role of the Fogarty catheter manipulation technique to reposition the PD catheter in the pelvis and regain patency. All patients with PD catheter malfunction caused by migration, confirmed by abdominal radiograph, underwent the same protocol. The patient was placed flat on the back, and the Fogarty was advanced into the PD catheter to a premarked point at which the end of the Fogarty was near the end of the PD catheter. The Fogarty balloon was inflated with 0.5 mL of sterile saline, and manipulation was performed by tugging movements until proper placement of the PD catheter into the pelvis was suspected. Infusion and drainage of dialysate was performed to determine patency. The return of the PD catheter into the pelvis was then confirmed by repeated radiograph. Success rates of Fogarty catheter manipulation, early and late recurrence (remigration < or =90 days or >90 days), and complications were prospectively examined in 232 patients over a 6-year period. Catheter migration occurred in 34 of 232 patients (15% incidence). All patients had curled-end, double-cuffed, non-swan-neck PD catheters. Successful repositioning occurred in 24 of 34 patients (71%). None of the 24 repositioned catheters had early recurrence, and 1 of 24 catheters (4%) had late recurrence. None of the patients had procedure-related peritonitis, bowel perforation, or exit-site trauma. These results show that PD catheter migration is relatively common (15%). The Fogarty manipulation technique is a simple, cost-effective way to prolong PD catheter life and preserve its long-term patency. This eliminates the need for surgical intervention in approximately 70% of patients with PD catheter migration.
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PMID:Role of Fogarty catheter manipulation in management of migrated, nonfunctional peritoneal dialysis catheters. 1067 30

We performed a retrospective analysis of our institution's experience with the technique of delayed externalization of subcutaneously tunnelled peritoneal dialysis catheters. From 1993 to 1999, 49 catheters were implanted in 37 patients. Median age of the patients was 43.6 years; 70% were female; 32% had diabetes. Most of the catheters were midline, single-cuff, curled Quinton catheters without a swan neck. One patient underwent transplantation prior to catheter externalization. One catheter leaked prior to externalization and was removed. The remaining catheters were externalized a median of 40 days (range: 18-319 days) post implantation. At externalization, two leaks and one omental obstruction occurred, causing primary catheter failure. Total days of catheter follow-up were 17,895. One-year and two-year catheter survival rates were 70% and 40% respectively. Catheter failure occurred owing to infection in 7 cases and to mechanical complications in 10 cases. The rate of exit-site infection was 1 per 9.9 patient-months, and of peritonitis, 1 per 16.2 patient-months. Including primary failures, mechanical complications were 12 hernias, 6 leaks, and 4 instances of malposition. We conclude that delayed externalization of single-cuff catheters without a swan neck is associated with increased mechanical and infectious complications. These findings may warrant a change to a double-cuff catheter with a swan neck.
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PMID:Subcutaneously tunnelled peritoneal dialysis catheters with delayed externalization: long-term follow-up. 1104 76

The swan neck presternal catheter is composed of 2 flexible (silicon rubber) tubes joined by a titanium connector at the time of implantation. The exit site is located in the parasternal area. The catheter located on the chest was designed to reduce the incidence of exit site infections compared to peritoneal dialysis catheters with abdominal exits. From August 1991 to September 30, 2001, 974 swan neck presternal catheters were implanted worldwide. At the university of Missouri, 150 of these catheters were implanted and followed for over 130 patient years. Presternal catheters tended to perform better than swan neck abdominal catheters regarding exit and tunnel infections, even though they were implanted in several patients in whom regular catheters with the exit on the abdomen would be difficult or impossible to implant. Two-year survival probability of presternal catheters was 0.95. Recurrent/refractory peritonitis was the only reason for catheter failure. The catheter is particularly useful in obese patients (body mass index >35), patients with ostomies, children with diapers and fecal incontinence, and patients who want to take baths without the risk of exit contamination. Many patients prefer presternal catheter because of better body image. Disadvantages of the presternal catheter are minimal. Compared with abdominal catheters, dialysis-solution flow is slightly slower because of the increased catheter length; however, slower flow is insignificant clinically. There is a possibility of catheter disconnection in the tunnel, but this complication is extremely rare in adults and easily corrected. Finally, the implantation technique is more challenging compared with that of single-piece, abdominal catheters.
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PMID:Presternal peritoneal catheter. 1208 89

Loss of the peritoneal dialysis (PD) catheter is a major cause of PD technique failure and transfer to hemodialysis. In the present study, we report our experience with permanent peritoneal catheters. We prospectively analyzed 125 double-cuff coiled, swan-neck catheters implanted by the open surgical method in 120 patients from January 1996 to June 2003. The patients were evaluated monthly and followed for a total of 2806 patient-months. The mean age of the patients was 55 +/- 17 years (range: 22 - 91 years); 52% were men; 20% had diabetes; 10% were receiving immunosuppressive treatment; 45% were Staphylococcus aureus nasal carriers; and 93.3% were on automated PD. Catheter survival was 97% at 2 years and 92.2% at 5 years. A total of 59 early and late catheter complications were observed in 36 patients. These included exit-site infection at a rate of 0.125 episodes/ patient-year. The most frequent noninfectious complications were herniation (8%), leakage (6%), and bloody dialysate (3%). Statistical analysis did not identify variables that predicted the development of exit-site infection. The overall peritonitis rate was 0.149 episodes/patient-year. Our data suggest that the main catheter complication is infection. The low incidence of infection in our study is probably related more to good installation technique and aftercare than to the clinical characteristics of the patients.
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PMID:Outcome of peritoneal dialysis: Tenckhoff catheter survival in a prospective study. 1538 16


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