Six-Year Experience with Swan Neck Presternal Peritoneal Dialysis Catheter

Abstract

Background The presternal peritoneal catheter is composed of two silicone rubber tubes joined by a titanium connector at the time of implantation, and has an exit on the chest. Objective Comparison of survival and complication rates of Swan neck abdominal catheters with those of the presternal catheter. Design Nonrandomized study with prospective collection of data between August 1991 and October 1997. Setting Tertiary referral center. Patients In 57 patients, 58 presternal catheters and, in 81 patients, 86 abdominal catheters were implanted. Patients chose the type of catheter; however, obese individuals and those with ostomies and previous catheter problems were encouraged to opt for the presternal catheter. Others chose the presternal catheter in order to take tub baths or use a whirlpool. Main Outcome Measures Life-table analyses of catheter survival censored for transplant, transfer, and death; reasons for catheter removal due to complications; and patient satisfaction. Results Two-year survival probabilities were 0.95 and 0.75 for presternal and abdominal catheters, respectively. Nine abdominal catheters were removed due to exit/tunnel infections (including five with peritonitis), and four due to peritonitis. External cuff shaving in four presternal catheters has extended survival for more than 1 year. Four presternal catheters were removed due to peritonitis. No catheters in either group were lost due to leakage or obstruction. The peritonitis rate was 1 episode per 37.4 patient-months and 1/20.5 patient-months for presternal and abdominal catheters, respectively. These differences are not significant. Patient acceptance of the presternal catheters was excellent; in the latest period, from January to October 1997, presternal catheters were chosen by 15/24 patients. Conclusions The trend to improved outcomes in presternal catheters continues to validate the rationale for presternal catheter design. Decreased frequency of exit/ tunnel infection may be due to more effective immobilization on the chest, less trauma, and avoidance of submersion in stagnant water. No specific contraindications to use of the presternal catheter have been identified.

Creating and Maintaining Optimal Peritoneal Dialysis Access in the Adult Patient: 2019 Update

“…The abdominal segment of 2-piece extended catheters ( Figure 1C) can be implanted by any of the above-mentioned insertion techniques (24,25,81,82). A secondary incision is made in the vicinity of the planned upper abdominal, presternal, or back exit site.…”

Opinion: Have New Materials, Shapes, and Designs of Peritoneal Dialysis Catheters Improved Their Function?

“…A 6-year experience with these catheters in one center showed reduced complications as compared to other catheters. Survival probabilities of 95% and 86% at 2 and 3 years, respectively, are the best results ever reported (23).…”

Peritoneal Dialysis Catheter Placement and Management

“…Exit site location of a presternal catheter should be at least 3 cm off the midline. A review showed a nonsignificant trend for improved survival and lower peritonitis rates was observed with presternal compared with abdominal catheters [12]. In a study of 200 patients, anthropometric analysis to help maximize the position of the catheter tip to a deep pelvic location and ideal exit site location found that the optimal catheter type may differ in men and women [13].…”