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The results obtained by means of the Tenckhoff and the Toronto Western Hospital-type (TWH) indwelling catheters for peritoneal access in patients undergoing Continuous Ambulatory Peritoneal Dialysis are reported. Fifty-nine Tenckhoff catheters were used for 592 months and 24 TWH-type for 220 months. One-year catheter survival was 71% in the Tenckhoff group and 77% in the TWH group. The difference does not reach statistical significance. Moreover no statistically significant differences as regards complications could be found between the two catheter types. A major disadvantage was noted with the TWH catheter: on two occasions TWH catheters could not be removed without a laparotomy, being firmly adherent to the intestine or omentum. It is concluded that the TWH catheter is not a superior alternative to the Tenckhoff catheter for peritoneal access in patients undergoing Continuous Ambulatory Peritoneal Dialysis.

In recent years there have been a number of clinical investigations utilizing intraperitoneal (IP) chemotherapy for the treatment of intracavitary and intrahepatic disease. The aim of this locoregional therapy is to provide high intratumor concentrations of antineoplastic agents while reducing the systemic exposure to these toxic drugs.

From May 1980 to April 1985, a total of 62 double-cuff Tenckhoff catheters were surgically implanted in 54 patients through a low medial laparotomy. The follow-up on continuous ambulatory peritoneal dialysis accounted for 1,029 patient-monthly. The patients who used a detachable double-bag system developed a total of four exit-site infections, one tunnel infection, three outer cuff erosions, four catheter dislocations, and two dialysate leaks. In five patients, the catheter had to be removed (one exit-site infection, two catheter breaks, and two catheter dislocations). Cumulative catheter survival using the method of life-time analysis was 81% and 70% after 1 and 2 years, respectively, considering all catheters implanted, and 92% and 92%, respectively, when peritonitis-related removal was excluded.

A patient treated by chronic peritoneal dialysis developed an abdominal wall hernia at the site of the Tenckhoff catheter. The hernia led to a complete small bowel obstruction which required surgical

One standard continuous ambulatory peritoneal dialysis (CAPD) infusion/drainage system was found prone to recurrent mechanical failure at the junction between the silastic catheter and the titanium connector. This resulted in slackening and eventual disconnection with attendant risk of bacterial entry and a CAPD-associated peritonitis. A simple “lock-ring” device, when fitted over the catheter-titanium connector junction, afforded a secure joint.

Seventeen cases of fungal peritonitis and one case of Nocardia asteroides peritonitis were observed in 141 patients during the first 5 years of our continuous ambulatory peritoneal dialysis program (CAPD). Fungal peritonitis accounted for 7% of the episodes of peritonitis observed in this interval. There were eight deaths associated with fungal peritonitis. In only three instances could factors predisposing to fungal peritonitis be identified. We were unable to predict who would develop fungal peritonitis by analysis of nutritional, demographic, or technical factors associated with the dialysis procedure. The diagnosis of fungal peritonitis was easily established using routine blood agar culture techniques. Successful management of these patients included prompt removal of the Tenckhoff catheter and intravenous (IV) administration of amphotericin.

Background The self-locating catheter invented by Nicola Di Paolo has been used increasingly in Italy and elsewhere since 1994, with about a thousand patients currently implanted every year. Twelve grams of tungsten inserted into the tip of the conventional Tenckhoff catheter during extrusion does not significantly change its form, but suffices to keep the tip firmly in the Douglas cavity. Objective The aim of the present study was to confirm our preliminary results in a large population of peritoneal dialysis patients. Setting 16 Italian nephrology departments. Results In addition to confirming the validity of the new catheter, the present results show that patients with the new catheter have fewer episodes of peritonitis, tunnel infection, cuff extrusion, catheter malfunction, obstruction, and leakage. Conclusion The present multicenter control study confirms preliminary results and demonstrates that complications of peritoneal dialysis, such as cuff extrusion, infection, peritonitis, early leakage, and obstruction, are statistically less frequent in patients with self-locating catheters than in patients with classic Tenckhoff catheters.

Starting peritoneal dialysis (PD) Immediately after insertion of a peritoneal dialysis catheter is essential in some patients. However, due to a poor insertion technique, leakage may occur in up to 20% of patients after insertion of a peritoneal dialysis catheter, for example, in the midline. PD was started in 50 consecutive patients (age range 7–81 years). Under local anesthesia the Tenckhoff catheter was inserted about 3 cm lateral to the linea alba (mostly to the right) near the navel. The ventral and dorsal fasciae of the rectus muscle were split sagitally before entering the peritoneal membrane by a small incision. One pursestring suture fixed the peritoneal membrane around the Inner cuff, while the second suture fixed the dorsal fascia of the rectus muscle around the outer side of the cuff. A third suture was placed around the catheter in the ventral fascia. Dialysis in all our patients was started peroperatively, Initially by the use of 1 L of peritoneal dialysis fluid (Dlaneal, Baxter Medical AB, Sweden). Bed rest for 2 or 3 days was requested of and performed by most patients. Only one early and no late leakages occurred. At reoperation of the patient with the leak, the second suture was found to have been loosened. The technique is easy to handle and enables immediate dialysis. The risk for leakage Is very low.

Background/Aims Currently there are several techniques for laparoscopic placement of peritoneal dialysis catheters. The aim of this paper is to describe our technique and outcomes. Patients and Methods Laparoscopic implantation of peritoneal catheters was performed in 100 consecutive patients. The technique employed laparoscopically guided mus-culofascial tunneling to maintain catheter orientation toward the deep pelvis, and adhesiolysis to eliminate compartmentalization that could affect completeness of dialysate drainage. Mean duration of surgery, hospital stay, morbidity, mortality, and catheter survival were assessed. Analysis of catheter survival was performed using the Kaplan–Meier method, with censoring of catheter loss due to death or successful transplantation. Results Mean operative time was 20 ± 7 minutes and average duration of hospital stay was 3 ± 1 days. There were no conversions from laparoscopy to conventional catheter insertion methods. No exit-site or tunnel infections, hemorrhagic complications, abdominal wall hernias, or catheter cuff extrusions were detected. No mortality occurred in this series of patients. Catheter survival was 97%, 95%, and 91% at 1, 2, and 3 years, respectively. Conclusions The laparoscopic method described in this report is compliant with consensus guidelines for best-demonstrated practices in peritoneal access placement. Laparoscopy permits direct visualization of all procedure steps in a safe efficient reproducible manner. The laparoscopic approach afforded patients the advantage of short procedure times, a minimally invasive approach, and excellent outcomes. The results reported in this paper support our opinion that laparoscopic Tenckhoff catheter implantation should become the standard of care for clinical practice.

Introducción: El objetivo del estudio fue comparar las complicaciones quirúrgicas, mecánicas e infecciosas que presenta el catéter autoposicionante frente a otros tipos de catéteres tipo Tenckhoff, así como comparar la supervivencia de ambos tipos de catéteres. Material y métodos: Estudio descriptivo retrospectivo multicéntrico, de 79 meses de duración. Se estudiaron todos los catéteres colocados en dos unidades de diálisis peritoneal. El análisis se realizó con el paquete estadístico IBM SPSS Statistics 19.0, estableciendo el nivel de significación en p

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.

Retrospective analysis of the results of several break-in techniques in our institution revealed that a 10 day delay in CAPD initiation after a midline Tenckhoff catheter insertion is sufficient to prevent leakage in patients maintained on intermittent peritoneal dialysis. A leak or obstruction related to an insufficient surgical technique can be promptly diagnosed and corrected. An irrigation technique seems to be useful in non-uremic patients, but frequently fails to disclose a one-way obstruction with a consequent delay in a surgical correction. Recently we have introduced a modification of this technique in which the patency of the catheter is checked with one in and out exchange using a small volume of dialysate during outpatient clinic visits every 2– 3 days.

Two months after cessation of continous cycling peritoneal dialysis a pa tient developed an infected intra abdominal hematoma while a Tenck hoff catheter was still present in the abdomen. The hematoma required surgical evacuation. This complication suggests that we should consider early removal of Tenckhot T catheters after successful renal transplanta tion or after switching to hemo dialysis. The chronic peritoneal catheter pioneered by Tenckhoff has made it possible to treat thousands of patients with end stage renal failure by chronic peritoneal dialysis. The complications of Tenckhoff catheters include dialysate leakage, outflow obstruction, pelvic pam, hydrothorax, dacron cuff extrusion, tract infections, combined inflow outflow obstruction, abdominal or in guinal hernias, and hydroceles (1–6). This paper describes a patient who developed abdominal pain and an in fected intra-abdominal hematoma two months after being transferred from continuous cycling peritoneal dialysis (CCPD) to hemodialysis. The appear ance of this complication two months after discontinuing peritoneal dialysis raises the question: When should one remove a Tenckhoff catheter after transfer to hemodialysis or successful renal transplantation?

A 44-year-old woman on CAPD for 20 months presented with severe intraperitoneal bleeding secondary to rupture of the spleen. On the day of the accident displacement of the Tenckhoff catheter to the left upper quadrant of the abdomen was detected by X-ray. We believe this dislodgement caused the rupture either by direct trauma or erosion of the organ. This complication of CAPD has not been described before. There are no previous reports of rupture of an abdominal organ during chronic peritoneal dialysis. However massive intraperitoneal hemorrhage in CAPD has been described secondary to abdominal wall erosion by the Tenckhoff catheter. We believe that rupture of the spleen in the present case was due to trauma and/or erosion induced by a displaced Tenckhoff catheter.

Over a period of 33 months a total of 2,146 peritoneal dialyses were carried out by means of indwelling Tenckhoff catheters in 65 patients suffering from terminal renal failure. The patients were maintained on peritoneal dialysis for periods varying from two weeks to 13 months. Treatment over long periods was possible in only a few cases. Infection and clotting, which tended to limit the functional life of the catheters, was reduced by rigid asepsis and by adding heparin to the dialysate. The Tenckhoff catheter was found to be valuable for peritoneal dialysis as a short-term measure, especially in patients in whom haemodialysis was not immediately feasible, in borderline cases when kidney function was not too seriously impaired, and as an alternative to haemodialysis when that was interrupted by complications.

To the Editor.— Rae and Pendray inThe Journal(225:937,1973) have recommended peritoneal dialysis with the silicone-rubber tube described by Tenckhoff and Schechter for permanent and temporary treatment of chronic renal failure. In our clinic, 82 Tenckhoff catheters were implanted in 65 patients during 33 months, with 2,146 peritoneal dialyses within 262 cumulative months. Clinical signs of peritonitis were observed in 21 patients; in ten of these treatment was effective and the catheter remained unimpaired. The other 11 had to be removed. In three cases fibrin clots obliterated the catheter lumen, in three others there was an infection of the skin tunnel, once a loosening of the catheter and once its penetration into the intestinal lumen occurred. During the present observation time the average survival time was just over three months, but in a few cases the catheter lasted for more than one year. The survival time was mainly limited

Sir: Usually, during peritoneal dialysis, perforation of intra-abdominal organs, that is, gut, bladder, liver, or aorta, is associated with catheter insertion into the abdomen. However, some workers have reported that, with time and with particular type of catheters, bowel perforation may occur due to pressure necrosis. This letter describes an unusual complication of the straight Tenckhoff catheter, perforation of the urinary bladder eight months after its implantation.

Excerpt To the editor: Many dialysis centers are initiating continuous ambulatory peritoneal dialysis with guidance from established programs. However, dialysis staff will inevitably face certain s...

The temporary Tenckhoff catheter has been utilized for intermittent peritoneal dialysis in 24 patients for periods from 1 to 14 months. Control of uremia has been comparable to our past experience with the repeated trocar puncture method. Although infection remains the most significant problem, it is avoidable by strict attention to sterile dialysis procedure and careful education of the patients concerning the daily care of their catheter and appreciation of its importance. The risk of infection under these circumstances is comparable to that of external arteriovenous shunts in hemodialysis. Our experience with the temporary Tenckhoff catheter warrants the conclusion that this catheter can be safely utilized and that peritoneal dialysis is an acceptable alternative or adjunct to hemodialysis.