4-YEAR EXPERIENCE WITH SWAN NECK PRESTERNAL PERITONEAL-DIALYSIS CATHETER

The swan neck presternal catheter is composed of two flexible (silicon rubber) tubes joined by a titanium connector at the time of implantat ion, The exit site is located in the presternal or parasternal area. T he catheter located on the chest was designed to reduce the incidence of exit site infections compared with peritoneal dialysis catheters wi th abdominal exit sites, From August 1991 to May 1995, 24 swan neck pr esternal catheters have been implanted in 24 patients for the followin g reasons: obesity nine patients, ostomies three patients, a suprapubi c catheter one patient, previous problems with abdominal catheters two patients, desire to use a bathtub five patients, need to use a whirlp ool one patient, need to wear sweatpants with an elastic waistband one patient, and body image two patients, In the same period, 47 abdomina l swan neck catheters were implanted in 44 patients who preferred cath eters with the exit on the abdomen, Presternal catheters tended to per form better regarding exit and tunnel infections, even though they wer e implanted in several patients in whom regular catheters with the exi t 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 fa ilure, The differences in results between presternal and abdominal cat heters were statistically insignificant; only the use of antibiotics t o treat exit site infection was significantly higher with abdominal ca theters, Patient acceptance of the exit position was good; at least se ven patients preferred presternal catheter for psychological or body i mage reasons, We conclude that the swan neck presternal catheters prov ide excellent results comparable to those achieved with swan neck abdo minal catheters, The catheter seems suitable for any patient commencin g peritoneal dialysis and is particularly useful in extremely obese pa tients (body mass index >40 kg/m(2)) and those with ostomies, The cath eter exit location in the chest may be preferred by some patients, bot h men and women, for psychological or body image reasons, No specific contraindications to the presternal catheter implantation have been id entified. (C) 1995 by the National Kidney Foundation, Inc.