Optimal peritoneal dialysis catheter type and exit site location: an anthropometric analysis

An anthropometric analysis of 200 adult patients was performed to provide better guidance in catheter selection and placement. Height, weight, various abdominal wall measurements, and gender effects were analyzed. Suitability of Tenckhoff catheters with straight and preformed bends in the intercuff segment was evaluated regarding ability to produce deep pelvic position of the catheter tip and ideal exit site location. Conflicts with belt line and with skin creases and folds were recorded. Results showed that abdominal wall measurements varied widely by height and weight. Swan neck catheters with a downwardly directed external limb and exit site were significantly better suited for females (62% versus 27%, p < 0.0001). Tenckhoff catheters with straight intercuff segments with a laterally directed tunnel tract and exit site were significantly better matched to males (78% versus 30%, p < 0.0001). Neither catheter was suitable in 25% of subjects, emphasizing the need for an extended catheter system capable of remotely locating the exit site to the upper abdomen or chest without compromising pelvic position of the catheter tip. Appropriate preoperative evaluation with selection of the best suited catheter should replace the substandard practice of using a pet catheter to fit all patients and rigidly placing the insertion incision at a set location irrespective of body habitus.