A New Approach for Catheter Placement and Care in CAPD

Abstract

Between April 1981 and December 1984, 54 double-cuff straight Tenckhoff catheters were inserted in 50 patients. This paper describes our experience with a new approach for catheter placement and care. It is based on a) ambulatory insertion by nephrologists; b) no flushing, heparinization or cycling; c) “break-in” delayed for two weeks and performed with regular two-liter bags; dialysis and d) ambulatory training carried out over 7–10 days. The actuarial survival rates of the catheters were 98% at 12 months and 80% at 24 and 36 months. Catheter failure was seen in six patients, three were due to peritonitis, two to tunnel infection and one to outflow obstruction caused by peritoneal adhesions. We conclude that this approach is feasible, safe, cheap and affordable and probably will produce less complications than other methods. Our nephrology section started a CAPD program in early 1981 but limited financial resources led us to devise a simplified and affordable protocol for catheter placement and care and for patient training and follow-up. Thus, we provide ambulatory catheter placement followed by two weeks without any type of peritoneal dialysis or catheter flushing. After this period, patients are trained as outpatients for seven to 10 days. This paper reports our experience with this approach.