Peritoneal catheter development. Currently used catheters--advantages/disadvantages/complications, and catheter tunnel morphology in humans.
Original Tenckhoff catheters are still the most commonly used catheters, and catheter survival rates are still unsatisfactory. Preliminary results with Swan Neck catheters, the catheters with a permanently bent intramural segment, are encouraging since these catheters are associated with low complication rates. The role of the external cuff in prevention of exit and tunnel infections is still controversial. Animal experiments indicate that collagen ingrowth into the external cuff is crucial in the inhibition of epidermal downgrowth. The author's recent preliminary observations on four catheter tunnels removed 1 month to 5.5 years after catheter implantations, indicate that 1) epidermal cells in humans do not spread deeper than a few millimeters from the skin exit and 2) the external cuff does not participate in the epidermal cell downgrowth inhibition. This is unlike animal studies. The difference in epidermal biology between humans and animals may render animal experiments difficult to apply to catheter technology in humans.
Twardowski
Z J
ZJ
Department of Medicine, University of Missouri, Harry S. Truman Veterans Administration Hospital, Dalton Research Center, Columbia 65212.
D000818:Animals; D001424:Bacterial Infections / Q000209:etiology; D002408:Catheters, Indwelling / Q000009:adverse effects*; D004817:Epidermis / Q000473:pathology; D004867:Equipment Design; D006801:Humans; D010530:Peritoneal Dialysis / Q000295:instrumentation*; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000295:instrumentation; D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene
D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene