A prospective randomized study comparing tenckhoff catheters inserted using the triple incision method with standard...

Area of Science:

• Nephrology
• Surgical Techniques
• Medical Devices

Background:

• Swan neck catheters may reduce exit-site infection (ESI) risk due to downward exit.
• Swan neck catheters have lower migration rates but are more expensive and lack guidewire manipulability.
• Conventional Tenckhoff catheters were modified with a downward exit using the triple incision method for comparison.

Purpose of the Study:

• To compare infective and mechanical complications between Tenckhoff catheters with downward exit (triple incision method) and swan neck catheters.
• To evaluate the efficacy and safety of the triple incision method for Tenckhoff catheter implantation.
• To assess catheter survival rates and complication profiles in both groups.

Main Methods:

• 101 new peritoneal dialysis patients were prospectively randomized.
• Patients received either a Tenckhoff catheter with downward exit (triple incision method group, TIMG, n=50) or a swan neck catheter (SNCG, n=51).
• Follow-up was conducted for 24 months, monitoring for exit-site infections, peritonitis, and catheter migration.

Main Results:

• Exit-site infection (ESI) rates were similar: 70% in TIMG vs 72.5% in SNCG (p=0.83).
• Peritonitis rates were comparable: 0.64 episodes/year in TIMG vs 0.68 episodes/year in SNCG (p=0.47).
• Tip migration occurred in 30% of TIMG patients versus 19.6% of SNCG patients (not statistically significant), with successful repositioning via guidewire in TIMG.

Conclusions:

• The triple incision method for Tenckhoff catheter placement achieves high survival rates with complication rates comparable to swan neck catheters.
• The triple incision method is a cost-effective alternative and allows for guidewire manipulation in cases of tip migration.
• This technique provides a viable option for peritoneal dialysis catheter implantation, balancing efficacy and cost.