title: A prospective randomized study comparing tenckhoff catheters inserted using the triple incision method with standard swan neck catheters.
abstract: OBJECTIVE
  The downward directed exit of the swan neck catheter may decrease the risk of exit-site infection (ESI). The percentage of migrations of the swan neck catheter seems to be less than the conventional Tenckhoff catheter and the swan neck catheter is more expensive and cannot be manipulated by guidewire technique if tip migration occurs. In this study, the conventional Tenckhoff catheter was used. The straight tunnel was converted to an arcuate one using the triple incision method, resulting in a downward directed exit. The arcuate tunnel was created by passing the catheter through an additional incision located between the paramedian incision and the exit site. We compared the infective and mechanical complications of the Tenckhoff catheter with a downward exit, implanted using the triple incision method, with the swan neck catheter.
  
  
  METHODS
  101 new peritoneal dialysis patients were prospectively randomized to receive either the Tenckhoff catheter with a downward exit, implanted using the triple incision method, or the swan neck catheter. Each patient was followed up for 24 months. 50 patients were in the triple incision method group (TIMG) and 51 were in the swan neck catheter group (SNCG).
  
  
  RESULTS
  Over a mean period of 18.9 +/- 8.0 months of follow-up, ESI occurred in 35 patients (70%) in TIMG and 37 patients (72.5%) in SNCG (p = 0.83). The ESI rates were 0.71 and 1.0 episodes/catheter-year in TIMG and SNCG respectively (p = 0.21). The peritonitis rates were similar in the 2 groups (0.64 episodes/year in TIMG and 0.68 episodes/year in SNCG, p = 0.47). More patients in TIMG had tip migration [15 patients (30%) in TIMG vs 10 patients (19.6%) in SNCG] but the difference was not statistically significant. Repositioning of the catheter by guidewire manipulation was successful in patients in TIMG but not in SNCG. Overall catheter survival at 12 and 24 months was 95% and 83% in TIMG and 93% and 79% in SNCG respectively (p = 0.72).
  
  
  CONCLUSIONS
  By using the conventional Tenckhoff catheter with a downward exit created using the triple incision method, high catheter survival rates with infective and mechanical complication rates similar to those of the swan neck catheter can be achieved. The triple incision method has the additional advantages of lower cost and the catheter can be manipulated by guidewire technique if tip migration occurs.
authors.affiliation: Dr. Lee Iu Cheung Memorial Renal Research Centre, Tung Wah Hospital, Department of Medicine, The University of Hong Kong, Hong Kong, SAR. terenceyip@netvigator.com
authors.forename: Terence
authors.initials: T
authors.lastname: Yip
authors.forename: Sing Leung
authors.initials: SL
authors.lastname: Lui
authors.forename: Kai Chung
authors.initials: KC
authors.lastname: Tse
authors.forename: Hong
authors.initials: H
authors.lastname: Xu
authors.forename: Flora S K
authors.initials: FS
authors.lastname: Ng
authors.forename: Suk Wai
authors.initials: SW
authors.lastname: Cheng
authors.forename: Tak Mao
authors.initials: TM
authors.lastname: Chan
authors.forename: Kar Neng
authors.initials: KN
authors.lastname: Lai
authors.forename: Wai Kei
authors.initials: WK
authors.lastname: Lo
mesh_terms: D000328:Adult; D057785:Catheters; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D010530:Peritoneal Dialysis / Q000295:instrumentation*; D011446:Prospective Studies