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Perit Dial Int 29(3): 278-284
2009
© 2009 International Society for Peritoneal Dialysis
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PD IN THE DEVELOPING WORLD

A RANDOMIZED TRIAL COMPARING CONVENTIONAL SWAN-NECK STRAIGHT-TIP CATHETERS TO STRAIGHT-TIP CATHETERS WITH AN ARTIFICIAL SUBCUTANEOUS SWAN NECK

Chiu-Leong Li1,a, Tai-Gen Cui1,2,a, Hong-Bing Gan1,3, Kin Cheung1, Weng-In Lio1 and Un-I Kuok1

Renal Department,1 Centro Hospitalar Conde de São Januário, Macao SAR; Department of Nephrology,2 Beijing Chaoyang Hospital, Capital University of Medical Science; Renal Division,3 Peking University First Hospital & Institute of Nephrology, Peking University, Beijing, China

a These authors contributed equally to this paper.

Correspondence to: U.I. Kuok, Renal Department, Centro Hospitalar Conde de São Januário, Macao SAR, China. kuokuni{at}ssm.gov.mo

{diamondsuit} Objective: To evaluate the safety and efficacy of inserting a straight-tip Tenckhoff catheter configured with a subcutaneous artificial swan neck.

{diamondsuit} Design: Clinical outcomes of conventional swan-neck straight-tip catheters and Tenckhoff straight-tip catheters implanted with an artificial subcutaneous swan neck were compared in a prospective randomized controlled trial in a single-center setting.

{diamondsuit} Patients and Methods: Patients undergoing peritoneal dialysis catheter insertion were randomized to receive either a double-cuff straight-tip Tenckhoff catheter with an artificial subcutaneous swan-neck (TC) or a conventional double-cuff straight-tip swan-neck catheter (SN). The primary outcome was catheter exit-site infection rate; the secondary outcomes were catheter-related mechanical events and surgery-related bleeding.

{diamondsuit} Results: A total of 39 consecutive patients were enrolled: 20 into the TC group and 19 into the SN group. More exit-site infections were observed in the SN group than in the TC group, although the difference was not statistically significant (0.97 vs 0.51 episodes per patient-year, p = 0.0657). However, there were more peritonitis episodes in the TC group than in the SN group (0.35 vs 0.15 episodes per patient-year, p = 0.0256). Exit-site and main wound bleeding post surgery were generally mild and similar in the 2 groups. No events of dialysate leakage, catheter tip migration, or subcutaneous cuff protrusion were observed in patients of either group. Outflow failure due to mechanical causes occurred in 2 patients in the TC group and in 1 patient in the SN group during the intermittent peritoneal dialysis period; all were corrected successfully by laparoscopic omentectomy.

{diamondsuit} Conclusions: Placement of the double-cuff straight-tip Tenckhoff catheter configured with an artificial subcutaneous swan neck appears to be an effective and safe procedure. It may be a good alternative to the conventional swan-neck catheter.

KEY WORDS: Peritoneal catheter; artificial swan neck; insertion; migration; exit-site infection.

Received 27 January 2007; accepted 17 July 2008.




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P. K.-t. Li and K. M. Chow
Importance of peritoneal dialysis catheter insertion by nephrologists: practice makes perfect
Nephrol. Dial. Transplant., November 1, 2009; 24(11): 3274 - 3276.
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