OBJECTIVE: Peritoneal catheters often become dislocated, and this may lead to malfunction. Since it is not usually possible to bring them back into their correct position, they must be replaced. With the aim of preventing this complication, we designed a new catheter. DESIGN: The new catheter has the same form as the Tenckhoff catheter except for a small increase in external diameter of the last 2 cm, made possible by the high specific weight of a small 12-g tungsten cylinder incorporated in the Silastic at the abdominal end. The new catheter may be inserted by a percutaneous technique. SETTING: University hospitals of Siena and Perugia, Italy. PATIENTS: In the last three years, 32 of these catheters have been implanted for a total experience of 468 patient-months. Their position was checked on insertion and every two months thereafter by radiography; 26 Tenckhoff catheters (415 patient-months) were studied at the same time. Insertion was performed surgically and by a percutaneous method. The frequency of cuff extrusion, exit-site infections, leakage, and peritoneal infection were noted, together with peritoneal function, which was evaluated by KT/V and weekly creatinine clearance one month after catheter insertion; the tests were repeated when dislocation occurred and at the end of the trial. RESULTS: No dislocations occurred with the self-locating catheters, whereas nine dislocations occurred in control patients (p = 0.0003). There were no significant differences with respect to controls for cuff extrusion, exit-site infections, leakage, peritoneal infection, and peritoneal function. CONCLUSIONS: The presence of a small weight at the catheter up prevents displacement completely, keeping the intraperitoneal part of the catheter in place.

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