Six-year experience with swan neck presternal peritoneal dialysis catheter

Background:The presternal peritoneal catheter is composed of two silicone r ubber 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 abdom inal catheters with those of the presternal catheter. Design: Nonrandomized study with prospective collection of data between Aug ust 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 w ith 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 fo r transplant, transfer, and death; reasons for catheter removal due to comp lications; and patient satisfaction. Results:Two-year survival probabilities were 0.95 and 0.75 for presternal a nd 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 remo ved due to peritonitis. No catheters in either group were lost due to leaka ge or obstruction. The peritonitis rate was 1 episode per 37.4 patient-mont hs and 1/20.5 patient-months for presternal and abdominal catheters, respec tively. These differences are not significant. Patient acceptance of the pr esternal catheters was excellent; in the latest period, from January to Oct ober 1997, presternal catheters were chosen by 15/24 patients. Conclusions: The trend to improved outcomes in presternal catheters continu es to validate the rationale for presternal catheter design. Decreased freq uency 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 i dentified.