Peritoneal dialysis catheter-related complications

Abstract

The introduction of a double-cuff swan neck type catheter has reduced the frequency of peritonitis. The frequency of complications associated with insertion of this catheter has remained unknown. We evaluated these complications in patients aged < 20 years at the start of the chronic peritoneal dialysis using double-cuff swan neck catheters. The data from 221 double-cuff swan neck catheters of 126 patients inserted in our hospital between 1990 and 2001 were compared with 102 single-cuff straight catheters of 54 patients between 1982 and 1990. The frequency of catheter-related complications, such as dislocation, leakage with in/outflow malfunction and infection(exit-site/tunnel infection and peritonitis within a month after catheter insertion) were estimated. We observed 37 dislocations(17%), 37 leakages(17%) and 36 infections(16%) of all double-cuff swan neck catheters. Twenty-nine catheters were removed due to catheter-related complications: 18 dislocations(8%), 2 leakages(1%) and 9 infections(4%). Catheter removal due to dislocation occurred significantly more frequently in 12% of children who were > or = 6 years old than in 1% of children < 6 years old(p = 0.002). Eighty-three percent of dislocations could be returned by the whiplash method(alpha-replacer, JMS, Tokyo). Of all single-cuff straight catheters, 10 catheters were removed due to catheter-related complications: 4 dislocations(4%), 6 leakages(6%) and 12 infections(12%). A single-cuff straight type catheter was more frequently replaced because of leakage and infection than a double-cuff swan neck type catheter. A double-cuff swan neck catheter was more frequently replaced because of dislocation than a single-cuff straight catheter. When a double-cuff swan neck catheter is inserted particularly in older children, care should be taken to avoid dislocation.