[Evaluation of peritoneal catheters and connection systems in peritoneal dialysis].
Evaluation of peritoneal catheters is based on the material, the number and type of cuffs, the length and intraperitoneal shape of the catheter, and its site of insertion. Final cost is another important issue which should take into account differences in the incidence of complications, in the number of hospitalizations, and in the simplicity of catheter insertion. Double-cuff catheters are used more than single-cuff catheters. The most commonly used catheter shapes are the classical Tenckhoff, the swan neck, the coil, and self-locating catheters. The latter are more expensive than Tenckhoff catheters but seem to offer some advantages, even if not sustained by adequate controlled trials so far. In addition, placement of these catheters may require different techniques or skills compared to the classical Tenckhoff. The most recent Italian guidelines based only on grade 1 and 2 evidence exclude that the type of catheter may influence the infection rate. There are no data from prospective controlled studies to evaluate the incidence of mechanical complications, hospitalization and technique survival. With regard to dialysis systems, it is still unclear if new plastic materials may offer any advantage over PVC. There is grade 1 evidence that Y-set and double-bag systems reduce the peritonitis rate compared to standard 1-way systems. The available data do not indicate significant differences in the incidence of peritonitis using Y-set compared with double-bag systems. The higher cost of double-bag systems is counteracted by shorter and easier training and by better acceptance by the patients.
De Vecchi
A F
AF
UOC di Nefrologia e Dialisi, Fondazione Ospedale Maggiore, Policlinico Mangiagalli e Regina Elena, Milano. deveccpd@policlinico.mi.it
D002404:Catheterization; D006801:Humans; D010530:Peritoneal Dialysis / Q000295:instrumentation*; D010537:Peritoneum