Why bury the distal end of the peritoneal dialysis catheter.
The first catheters for peritoneal dialysis were made in silicone with a Dacron cuff, which allowed tissue ingrowth, creating a barrier to the entrance of bacteria from the skin surface. However, the interruption of the skin envelope produces recurrent exit site and tunnel infections and peritonitis, which are the leading causes of discontinuing peritoneal dialysis. Experimental evidence suggests that the use of a double cuff silastic catheter and subcutaneous implantation of the distal catheter for 5-6 weeks before exposure reduces such infections, thus improving catheter life. Early preparation of peritoneal dialysis access with subcutaneous implantation allows healing of scar tissue into the cuffs and formation of an excellent bacteriological barrier.
Jack Moncrief Group and Moncrief Dialysis Center, Austin, TX 78705, USA. jbmoncrief@msn.com
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Moncrief
D002404:Catheterization / Q000379:methods*; D002408:Catheters, Indwelling / Q000009:adverse effects; D004867:Equipment Design; D006801:Humans; D010530:Peritoneal Dialysis / Q000295:instrumentation*