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Preliminary results with the Swan neck presternal catheter for CAPD in children
M Sieniawska1, M Roszkowska-Blaim, S Warchol
1Department of Pediatrics and Nephrology, Children's University Hospital of Medical Academy, Warsaw, Poland.
Insights
Swan neck presternal catheters (SNPCs) may reduce exit-site infections (ESIs) in children undergoing continuous ambulatory peritoneal dialysis (CAPD). This study found no catheter-related issues in five pediatric patients using SNPCs, suggesting a potential benefit for ESI prevention.
Area of Science:
- Pediatric Nephrology
- Surgical Innovation
- Infectious Disease Prevention
Background:
- Exit-site infection (ESI) is a common complication in children on continuous ambulatory peritoneal dialysis (CAPD).
- Obesity, young age, and diaper use are risk factors associated with higher ESI rates.
- Traditional catheter exit sites can be prone to contamination and trauma.
Purpose of the Study:
- To evaluate the safety and efficacy of Swan neck presternal catheters (SNPCs) in pediatric patients on CAPD.
- To assess the potential of SNPCs in reducing the incidence of exit-site infections in a high-risk pediatric population.
- To explore the advantages of a presternal catheter exit site for managing CAPD in children.
Main Methods:
- A prospective study involving five pediatric patients (aged 2-11 years) on CAPD.
- Implantation of five Swan neck presternal catheters (SNPCs) between December 1991 and February 1993.
- Patients were selected based on criteria including young age, obesity, recurrent ESI, and diaper use.
Main Results:
- No catheter-related problems were observed during the study period.
- The observation period ranged from 1-10 months, with 1-9 months on CAPD using SNPCs.
- The presternal location facilitated easier exit-site care and potentially reduced infection risk.
Conclusions:
- Swan neck presternal catheters (SNPCs) appear to be a safe and viable option for pediatric patients on CAPD.
- The presternal catheter exit site may offer advantages in reducing ESI risk, particularly in children with risk factors like obesity and diaper use.
- Further research is warranted to confirm the long-term benefits of SNPCs in preventing ESI in this population.
Abstract:
Exit-site infection (ESI) in children on continuous ambulatory peritoneal dialysis (CAPD) is a complication observed mainly in obese patients and patients wearing diapers. From 15 December 1991 to 28 February 1993, five Swan neck presternal catheters (SNPCs) were implanted in 5 children aged 2-11 years. The criteria for insertion of a SNPC were the following: young age in 1 child, obesity in 2, recurrent ESI in 2, and the use of diapers in 2. In some patients there was more than one criterion. The observation period ranged from 1-10 months, and the time on CAPD with the SNPC was 1-9 months. During this period, we did not observe any catheter-related problems. The potential advantages of the chest location of the catheter exit site are the following: 1. easy exit-site care; 2. decreased risk of ESI in small children because of greater distance from wet diapers; 3. avoidance of trauma with crawling/creeping; and 4. better healing and decreased risk of ESI in the area with less fat thickness.