title: Comparative analysis of two-piece extended peritoneal dialysis catheters with remote exit-site locations and conventional abdominal catheters.
abstract: BACKGROUND
  An alternative peritoneal catheter exit-site location is sometimes needed in patients with obesity, floppy skin folds, intestinal stomas, urinary and fecal incontinence, and chronic yeast intertrigo. Two-piece extended catheters permit remote exit-site locations away from problematic abdominal conditions.
  
  
  OBJECTIVE
  The effect on clinical outcomes by remotely locating catheter exit sites to the upper abdomen or chest was compared to conventional lower abdominal sites.
  
  
  METHODS
  In a nonrandomized design, peritoneal access was established with 158 extended catheters and 270 conventional catheters based upon body habitus and special clinical needs. Prospective data collection included patient demographics, infectious and mechanical complications, and catheter survival.
  
  
  RESULTS
  Kaplan-Meier survival time until first exit-site infection was longer for extended catheters (p = 0.03). Poisson regression showed no difference in exit site, subcutaneous tunnel, and peritonitis infection rates; however, the proportion of catheters lost during peritonitis episodes was significantly greater for extended catheters (p = 0.007) and appeared to be due primarily to coagulase-negative staphylococcus organisms. Poisson regression showed interactions of body mass index (BMI) and diabetic status in determining catheter loss from peritonitis for both catheter types (p = 0.02). Extended catheter patients had higher BMI and diabetes prevalence (p < 0.0001). Overall extended catheter survival at 1, 2, and 3 years (92%, 80%, 71%) trended lower than conventional devices (93%, 87%, 80%; p = 0.0505).
  
  
  CONCLUSIONS
  Extended catheters enable peritoneal access for patients in whom conventional catheter placement would be difficult or impossible. Certain patient and extended-catheter characteristics may contribute to loss from peritonitis.
authors.affiliation: Department of Surgery, Southern California Permanente Medical Group, Kaiser Permanente Downey Medical Center, Downey, California, USA. John.H.Crabtree@kp.org
authors.forename: John H
authors.initials: JH
authors.lastname: Crabtree
authors.forename: Raoul J
authors.initials: RJ
authors.lastname: Burchette
mesh_terms: D000005:Abdomen; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D057785:Catheters / Q000009:adverse effects; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D011446:Prospective Studies; D013909:Thorax