The Catheter as Ariadne's Thread to Follow the Path of Peritoneal Dialysis (PD) through the Long-Term Experience of a Center

Abstract

In our institution, the first patient was treated by HD in 1955. In the middle of the '60s, the PD technique, revised by Maxwell (1), was implemented. The access to peritoneum was obtained by repeated puncturing of the abdomen, the catheter being removed after each session. In 1966, our first results on one year of PD were published (20 patients treated, 13 affected by ARF and 7 by CRF, for a total number of 150 sessions). Since 1967, the procedure of the repeated punturing was improved by the Seldinger technique. The efficiency of the PD intermittent treatment was increased with the "fast shift" schedule and PD automation was pursued with the project of a cycler (1968). The first CRF patients were treated by fast shift PD. In the late intermittent PD phase, the adoption of permanent catheters, destined to endure in our practice, the rigid and the soft indwelling for long-term treatments, allowed us to launch programs of home and nocturnal PD. With the incoming CAPD age, the greatest care was directed to the role of the catheter. The adoption of the surgical insertion by paramedian approach through rectus muscle, minimized, in our experience, the early complications. With the reduction of peritonitis rate, the later catheter complications increased in terms of patient discomfort, hospitalization and technique survival. On those grounds, in our institution a prospective trial on a ten year period was undertaken to compare, in terms of late complications rate, new versions of the classic Tenckhoff straight catheter (ST). The surgical insertion method was adopted for all the types, for a total of 196 catheters in 163 CRF patients. The tip displacement rate (12.2% with ST) decreased, albeit non significantly, with Swan Neck (7.9%), but was markedly and significantly reduced (1.0%) with the Self-Locating (SL) catheter experience. The surgical insertion of SL was comparable to that of ST. For those reasons, in recent years, in our institution the SL catheter became the first choice catheters for CRF patients.