Acute peritoneal dialysis utilizing a non-luminal channeled catheter in infants

Acute peritoneal dialysis in unstable infants is at times plagued by early catheter malfunction secondary to omental plugging in both rigid acute catheters and conventional Tenckhoff catheters. This problem is inherent to the design of catheters using sideports for outflow and is enhanced by the tenacity of the omentum in this population in walling off foreign bodies. We have modified and utilized a non-luminal, channeled surgical drain for acute peritoneal dialysis in infants to avoid this problem. Five infants ranging in age from 2 days to 7 months were dialyzed acutely in a Pediatric Intensive Care Unit setting for periods ranging from 5 to 34 days utilizing this modified catheter. The infants ranged in weights from 1.96 to 8 Kg. Catheters were placed by a surgeon and peritoneal dialysis was initiated using a Y-setup. In none of the patients was there loss of catheter function secondary to omental plugging. Three patients subsequently died of their underlying illness and two recovered renal function. Two acute catheters were subsequently changed to conventional Tenckhoff catheters when it became apparent that dialysis would need to be performed for a prolonged time. The acute catheter which was used has a four channel cloverleaf appearance when cut in cross section with no central lumen. There is a transition to a luminal catheter outside the peritoneal cavity. The advantage of the cloverleaf configuration is the ability to exchange fluid along its entire intraperitoneal length, thereby excluding a defined area of catheter sideports where omentum can occlude the system causing a ball valve phenomenon.(ABSTRACT TRUNCATED AT 250 WORDS)