SWAN NECK PRESTERNAL PERITONEAL-DIALYSIS CATHETER - 5-YEAR EXPERIENCEIN CHILDREN

Objectives: To reduce the incidence of exit-site infection (ESI) a new peritoneal dialysis (PD) catheter, the Swan neck presternal catheter (SNPC), composed of abdominal and presternal parts joined by a titaniu m connector, with the exit site located on the chest wall, was designe d. Design: A prospective study was undertaken to estimate the usefulne ss of the SNPC for continuous ambulatory peritoneal dialysis (CAPD) in children. Setting: University Children's Hospital, Medical Academy, W arsaw, Poland. Patients: From December 1991 to June 1997, 11 SNPCs wer e implanted In 10 children for the following reasons: recurrent ESI in 3, the presence of ureterocutaneostomies in 3, obesity in 3, the use of diapers in 2, young age in 1, and fecal incontinence in 1. More tha n one indication was present in some patients. In 7 patients the SNPC was the first PD catheter inserted. Intervention: In all children the presternal catheter was implanted surgically by the modification of th e technique described by Twardowski et al. Results: The observation pe riod ranged from 1 - 60 months. The rate of ESI was 1/162 patient-mont hs. The major complication was trauma of the exit site (4 times in 3 o f 10 patients). In spite of leaving an extra length of the catheter in the entire subcutaneous tunnel at the time of implantation, the two p arts of the SNPC became disconnected in 2 children (after 7 and 33 mon ths respectively). Conclusion: Our results achieved with the SNPC in c hildren are very good. The presternal catheter reduces the risk of ESI . However, the chest localization of the exit site does not help to pr event trauma in children. This type of PD catheter should be reserved for patients with specific indications.