A New Self-Locating Peritoneal Catheter

Abstract

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 small12-g tungsten cylinder incorporated in the Silasticat the abdominal end. The new catheter may be inserted by a percutaneous technique. Setting University hospitals of Sienaand Perugia, Italy. Patients In the last three years, 32 of these catheters have been implanted for a total experience of 468 patientmonths. 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 KTN 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 tip prevents displacement completely, keeping the intraperitoneal part of the catheter in place.

Pre-clinical Evaluation of a Variable Length and Conforming Peritoneal Dialysis Catheter Weighted Anchor: In Vitro Analysis and Cadaver Feasibility Study

“…Di Paolo, et al, attempted to ameliorate the problem of PD catheter migration by introducing the "selflocating peritoneal dialysis catheter" (SLPDC) in 1996. [10] This PD catheter is similar to the straight Tenckhoff catheter in form, but is modi ed with a 12 g tungsten cylinder incorporated in the tip to keep the catheter tip in the retrovesical space through gravitational forces. Multiple studies have shown improved function, decreased migration, and longer catheter survival with the SLPDC.…”

“…Multiple studies have shown improved function, decreased migration, and longer catheter survival with the SLPDC. [9][10][11][12][13][14] However, drawbacks of the SLPDC include the signi cantly increased diameter of the terminal tungsten cylinder compared to the nominal diameter of the catheter precluding the ability to place it percutaneously through small sheaths, its inability to vary the length of the effective catheter, and its restricted application to a straight catheter instead of a coiled catheter.…”

Chronic peritoneal dialysis in children

“…9 There have been many modifications to catheter design since then, including weighted devices to hold the tubing in the pelvis. 8,10 Other adaptations include immobilizer devices and catheters with longer tubing designed for specific situations. 11 There is no firm agreement on optimum catheter configuration.…”

Laparoscopic treatment of large bowel obstruction due to a self-locating peritoneal dialysis catheter

“…The first models were based on the classical Tenckhoff design, with variations in the number or shape (polyester fiber, disc-ball, etc.) of the cuffs, in the design of the tip (straight, coiled), and in the shape of the subcutaneous portion (straight or with a permanent bend); ”named” models, with variations mainly in the intraperitoneal segment (the T-fluted Ash, the Lifecath, the Toronto-Western, the Ronco, and the Valli catheters) or materials (the Cruz catheter); and new models, also based on the Tenckhoff design, but with functional modifications, such as the Vicenza “short” catheter (with a shorter intraperitoneal segment for a lower insertion that prevents dislocation and improves body image acceptance) or the Di Paolo self-locating catheter, with tungsten attached to the tip for keeping it firmly in the Douglas pouch [ 3 , 5 ].…”