Tenckhoff Peritoneal Dialysis Catheter Research Articles

Treatment of Lymphocele Associated with Renal Transplant

A new method of operative drainage of lymphoceles following renal transplantation is described. The technique involves intraperitoneal marsupialisation of the lymphocele cavity followed by insertion of a Tenckhoff peritoneal dialysis catheter to splint open the peritoneal window and act as an internal drain.

Prospective Evaluation of a Dacron Cuffed Hemodialysis Catheter for Prolonged Use

Double lumen subclavian venous hemodialysis catheters are in wide use in the United States to provide temporary vascular access. The disadvantages of these catheters include a high infection rate and short use-life (2 to 3 weeks). We evaluated a felt cuffed tunnelled jugular venous hemodialysis catheter (PermCath) to determine its ability to overcome these shortcomings and compared it with standard noncuffed double lumen dialysis catheters. Eighty PermCaths were inserted during this prospective study in patients needing temporary vascular access in excess of 1 month. Median use-life of these catheters was 8 weeks with a use range of 3 weeks to 5.4 months. Only four functioning catheters failed before elective removal. Despite the prolonged use-life there was only one episode of catheter mediated bacteremia. Seven catheters (9%) failed to function immediately after insertion. These failures were caused by catheter kinking in the region of the felt cuff. Thrombosis of the catheter lumen was the most frequent complication (137 episodes) but resolved in over 95% of the instances with urokinase instillation. Exit site infections (23 instances) were successfully treated conservatively. We conclude that the PermCath (Quinton Instrument Co, Seattle) is a safe and reliable new device with a low complication rate and a longer use-life than standard subclavian dialysis catheters. This longer use-life allows more time for maturation of primary arteriovenous (AV) fistulas and Tenckhoff peritoneal dialysis catheters, and provides time for the healing of infected vascular access grafts. Its primary disadvantage is the need for surgical insertion.

Tenckhoff peritoneal dialysis catheters: the use of fluoroscopy in management.

Manipulation of the Tenckhoff catheter under fluoroscopic guidance is a useful procedure in patients who undergo chronic ambulatory peritoneal dialysis (CAPD). We reviewed 50 manipulations in 28 patients. There were no significant complications attributable to the procedure. Ten per cent of the manipulations were performed for visceral pain, 40% for malfunction within the first two weeks of catheter placement, and the remaining 50% for malfunction after two weeks of adequate dialysate flow. Overall, an initial success rate of 88% was recorded, and, after long term study, a durable success rate of 58% was demonstrated. Early malfunction (i.e., within the first two weeks) is a more ominous prognostic indicator than previously realized, with only 30% of these manipulations ultimately succeeding vs. 60% of manipulations in late onset catheter failure. Nevertheless, at least one attempt is warranted in manipulation of a malfunctioning Tenckhoff catheter.

Surgical aspects of the Tenckhoff peritoneal dialysis catheter: A 7 year experience

The experience with CAPD using the Tenckhoff catheter in 115 patients over a 7 year period has been reviewed. The general indications for CAPD in the patient with chronic renal failure are the mental and physical ability of the patient or his relatives to perform CAPD. In our series, diabetes mellitus has been a relative indication for CAPD, because diabetic patients often have vascular disease severe enough to make long-term hemodialysis difficult. The general contraindications are abdominal problems such as hernias, abdominal wall infections, inflammatory bowel disease, adhesions, and gastrointestinal stomas. Other contraindications are lumbar disk disease and respiratory insufficiency. The surgical principles of catheter insertion have been described. Complications associated with the Tenckhoff catheter were either mechanical (intraabdominal organ injury, incisional hernia, catheter leakage, catheter occlusion, or catheter dislodgement), or infectious (peritonitis or abdominal wall infection). The single most common organism isolated from effluent dialysate in 65 patients with peritonitis was Staphylococcus epidermidis in six patients (9.2 percent), and in 20 patients (30.8 percent), no organism could be isolated. For those patients who had peritonitis, the average frequency was at 8.9 months of CAPD. There were only three deaths (3 percent) directly related to the Tenckhoff catheter and these were due to peritonitis and sepsis. Only 22 (19 percent) of the 115 patients in this series had to discontinue CAPD because of its ineffectiveness or the patient's or relative's inability to perform CAPD.

Tenckhoff peritoneal dialysis catheter: cannulography and manipulation.

The Tenckhoff catheter is a permanently implanted peritoneal access cannula widely used for acute or chronic peritoneal dialysis. Failure of the cannula is usually due to the development of blocking adhesions or malposition. In 14 of 18 patients with inadequately functioning Tenckhoff catheters, catheter manipulation resulted in restoration of function. There were no complications.