Curl catheter

curl catheter

8811313010 CATH, CURL, 62CM, 2 CUFF Peritoneal Two Cuff Curl Curl Cath 62Cm 2 Cuff, 1/Each. Disruption of the shape memory of a peritoneal dialysis catheter at the time of Figure 1The Swan Neck Curl Cath Missouri peritoneal dialysis catheter. The Argyle Curl Cath Peritoneal Catheter is made of a highly kink-resistant, silicone that provides comfort for the patient by reducing the likelihood of skin.

Curl catheter - topic, very

Argyle™* Pediatric Peritoneal Dialysis Catheters

Argyle™* Pediatric Curl Cath Catheter

Product Details

A modified Tenckhoff catheter, the Argyle™* pediatric curl cath peritoneal catheter is suitable for pediatric patients, for acute or chronic peritoneal dialysis and intraperitoneal chemotherapy. It can be inserted either percutaneously or surgically. The additional mass of the Argyle™* pediatric curl cath peritoneal catheter keeps it low in the pelvic gutter, resulting in less catheter migration. The catheter’s curled tubing and numerous inflow/outflow holes diffuse dialysate gently into the patient.

Order Information

Order CodeDescriptionUnit of MeasureQuantity
8815677001Argyle™* Pediatric Curl Cath Catheter, 1 Cuff, 39 cmEach1

Argyle™* Pediatric Swan Neck Curl Cath Missouri Catheter

Product Details

The Argyle™* pediatric swan neck curl cath Missouri peritoneal dialysis catheter is suitable for pediatric patients.  The catheters’ design provides additional mass to keep it low in the pelvic gutter, resulting in less catheter migration. A silicone bead rests just inside the peritoneum and is designed to prevent dialysate leakage. The pre-formed 180° angle swan neck is designed to keep both the internal and external portions of the catheter positioned downward. They are intended to keep the internal portion from migrating out of position and to decrease stress on the exit site by the external portion, which often occurs when a straight catheter is manually curved during placement. The curled portion has numerous inflow/outflow holes to diffuse dialysate gently into the patient.

Order Information

ORDER CODEDESCRIPTIONUNIT OF MEASUREQUANTITY
8888415307Argyle™* Pediatric Swan Neck Curl Cath Missouri Catheter, 2 Cuffs, Left, 42 cmEach1

Argyle™* Pediatric Swan Neck Curl Cath Catheters

Product Details

Argyle™* pediatric swan neck curl cath peritoneal catheters are suitable for pediatric patients.  They are different from other catheters due to a pre-formed 180° angle designed to keep both the internal and external portions of the catheter positioned downward. The catheter is intended to keep the internal portion from migrating out of position and to decrease stress on the exit site by the external portion, which often occurs when a straight catheter is manually curved during placement. The additional mass of the curled catheter keeps the catheter low in the pelvic gutter, resulting in less catheter migration. The numerous catheter inflow/outflow holes diffuse dialysate gently into the patient.

Order Information

ORDER CODEDESCRIPTIONUNIT OF MEASUREQUANTITY
8888413100Argyle™* Infant Swan Neck Curl Cath Catheter, 2 Cuffs, 38.9 cmEach1
8888414813Argyle™* Pediatric Swan Neck Curl Cath Catheter, 2 Cuffs, Left, 42 cmEach1
8888413101Argyle™* Pediatric Swan Neck Curl Cath Catheter, 2 Cuffs, 43 cmEach1
8888413102Argyle™* Adolescent Swan Neck Curl Cath Catheter, 2 Cuffs, 59 cmEach1

Argyle™* Pediatric Tenckhoff Catheters

Product Details

Argyle™* pediatric Tenckhoff catheters are suitable for pediatric patients and are used for short-term and long-term peritoneal chemotherapy.  They are standard peritoneal catheters that come in a variety of lengths and cuff configurations to include one (1) attached cuff or two (2) attached cuffs.

Order Information

ORDER CODEDESCRIPTIONUNIT OF MEASUREQUANTITY
8888414219Argyle™* Pediatric Tenckhoff, 1 Cuff, 30 cmEach1
8812329001Argyle™* Pediatric Tenckhoff, 1 Subcutaneous Cuff, 31 cmEach1
8812321001Argyle™* Pediatric Tenckhoff, 1 Subcutaneous Cuff, 37 cmEach1
8888414201Argyle™* Pediatric Tenckhoff, 2 Cuffs, 30 cmEach1
8812329002Argyle™* Pediatric Tenckhoff, 2 Cuffs, 31 cmEach1
8888414227Argyle™* Pediatric Tenckhoff, 2 Cuffs, 31 cmEach1
8881090014Argyle™* Pediatric Tenckhoff, 2 Cuffs, 32 cmEach1
8810890003Argyle™* Pediatric Tenckhoff, 2 Cuffs, 37 cmEach1

Argyle™* Pediatric Swan Neck Tenckhoff Catheter

Product Details

The Argyle™* pediatric swan neck Tenckhoff catheter is different from other catheters due to a pre-formed 180° angle designed to keep both the internal and external portions of the catheter positioned downward. The catheter is intended to keep the internal portion from migrating out of position and to decrease stress on the exit site by the external portion, which often occurs when a straight catheter is manually curved during placement.

Order Information

ORDER CODEDESCRIPTIONUNIT OF MEASUREQUANTITY
8888410506Argyle™* Pediatric Tenckhoff Swan Neck Catheter, 2 Cuffs, Left, 37.5 cmEach1
Источник: [https://torrent-igruha.org/3551-portal.html]

Argyle™* Peritoneal Dialysis Catheters

Argyle™* Swan Neck Presternal Peritoneal Dialysis Catheter

Product Details

The Argyle™ swan neck presternal peritoneal catheter has an exit site located on the upper chest wall instead of at the belt line, making it ideal for patients with a more active lifestyle, obese patients who may have difficulty manipulating a catheter at the belt line and incontinent patients.

The presternal (upper) segment of the Argyle™ swan neck presternal peritoneal catheter is tunneled into the subcutaneous tissue of the chest wall. The upper segment connects with the intraperitoneal (lower) segment with a double-barbed titanium connector. Both the presternal and intraperitoneal segments can be trimmed in order to custom fit the patient. The intraperitoneal segment is a variation of the Missouri catheter. The pre-formed 180° angle is designed to keep both the internal and external portions of the catheter positioned downward. The angled catheter is designed to keep the internal portion from migrating out of position and to decrease stress on the exit site, which often occurs when a straight catheter is manually curved.

Order Information

Order CodeDescriptionUnit of MeasureQuantity
8888414011Swan Neck Presternal Peritoneal Catheter*, 2 Cuff, 112.8 cm (Swan Neck Catheter, 60.3 cm and Lower Abdominal Curl Catheter, 52.5 cm) Carton1

Argyle™* Swan Neck Curl Cath Peritoneal Dialysis Catheter

Product Details

The Argyle™ swan neck curl cath peritoneal catheter is designed to keep the internal portion of the catheter from migrating out of position and decreases stress on the exit site, preventing debris from collecting at the exit site.

Argyle™ swan neck curl cath peritoneal catheters are different from other catheters due to a pre-formed 180° angle designed to keep both the internal and external portions of the catheter positioned downward. The catheter is intended to keep the internal portion from migrating out of position and to decrease stress on the exit site by the external portion, which often occurs when a straight catheter is manually curved during placement. The additional mass of the curled catheter keeps the catheter low in the pelvic gutter, resulting in less catheter migration. The numerous catheter inflow/outflow holes diffuse dialysate gently into the patient.

Order Information

Order CodeDescriptionUnit of MeasureQuantity
8888413807Argyle™ Swan Neck Curl Cath Catheter, 2 Cuff, Left, 62.5 cmCarton1
8888413815Argyle™ Swan Neck Curl Cath Catheter, 2 Cuff, Right, 62.5 cmCarton1

Argyle™* Swan Neck Missouri Peritoneal Dialysis Catheter

Product Details

Argyle™ swan neck Missouri peritoneal catheters are designed to stop dialysate leakage while preventing catheter migration.

The Argyle™ swan neck Missouri peritoneal dialysis catheters' design provides additional mass to keep the catheter low in the pelvic gutter, resulting in less catheter migration. A silicone bead rests just inside the peritoneum and is designed to prevent dialysate leakage. The pre-formed 180° angle swan neck is designed to keep both the internal and external portions of the catheter positioned downward. The catheter is intended to keep the internal portion from migrating out of position and to decrease stress on the exit site by the external portion, which often occurs when a straight catheter is manually curved during placement. This catheter is indicated for patients who experience dialysate leakage.

Order Information

Order CodeDescriptionUnit of MeasureQuantity
8888412601Argyle™ Swan Neck Missouri Catheter, 2 Cuff, Left, 44.5 cmCarton1
8888412619Argyle™ Swan Neck Missouri Catheter, 2 Cuff, Right, 44.5 cmCarton1

Argyle™* Swan Neck Curl Cath Missouri Peritoneal Dialysis Catheter

Product Details

Argyle™ swan neck Missouri peritoneal catheters are designed to stop dialysate leakage while preventing catheter migration.

The Argyle™ swan neck curl cath Missouri peritoneal dialysis catheters’ design provides additional mass to keep the catheter low in the pelvic gutter, resulting in less catheter migration. A silicone bead rests just inside the peritoneum and is designed to prevent dialysate leakage. The pre-formed 180° angle swan neck is designed to keep both the internal and external portions of the catheter positioned downward. They are intended to keep the internal portion from migrating out of position and to decrease stress on the exit site by the external portion, which often occurs when a straight catheter is manually curved during placement. The curled portion has numerous inflow/outflow holes diffuse dialysate gently into the patient.

Order Information

Order CodeDescriptionUnit of MeasureQuantity
8888413401Argyle™ Swan Neck Curl Cath Missouri Catheter, 2 Cuff, Left, 62 cmCarton1
8888413419Argyle™ Swan Neck Curl Cath Missouri Catheter, 2 Cuff, Right, 62 cmCarton1

Argyle™* Swan Neck Tenckhoff Peritoneal Dialysis Catheter

Product Details

The Argyle™ swan neck Tenckhoff catheter is designed to keep the internal portion of the catheter from migrating out of position and decreases stress on the exit site, preventing debris from collecting at the exit site.

The Argyle™ swan neck Tenckhoff catheter is different from other catheters due to a pre-formed 180° angle designed to keep both the internal and external portions of the catheter positioned downward. The catheters are intended to keep the internal portion from migrating out of position and to decrease stress on the exit site by the external portion, which often occurs when a straight catheter is manually curved during placement.

Order Information

Order CodeDescriptionUnit of MeasureQuantity
8888412007Argyle™ Swan Neck Tenckhoff Peritoneal Catheter, 2 Cuff, Left, 43 cm Carton1

Argyle™* Swan Neck Oreopoulos-Zellerman Peritoneal Dialysis Catheter

Product Details

Argyle™ swan neck Oreopoulos-Zellerman Missouri Tenckhoff peritoneal catheters are designed to prevent omental wrapping and to keep the catheter placed low in the pelvis.

With the addition of two silicone discs in the internal catheter segment, the Argyle™ Oreopoulos-Zellerman Missouri Tenckhoff peritoneal catheters prevent omental wrapping and keeps the catheter placed low in the pelvis. The Missouri configuration adds a silicone bead and a felt disc (flange). The felt disc is placed just outside the peritoneum and is sutured to the rectus muscle. The bead rests just inside the peritoneum to prevent dialysate leakage.

Order Information

Order CodeDescriptionUnit of MeasureQuantity
8888413005Argyle™ Swan Neck Oreopoulos-Zellerman Catheter, 2 Cuff, Left, 44.5 cmCarton1
8888413013Argyle™ Swan Neck Oreopoulos-Zellerman Catheter, 2 Cuff, Right, 44.5 cmCarton1

Argyle™* Moncrief-Popovich Swan Neck Curl Cath Peritoneal Dialysis Catheter

Product Details

Argyle™ Moncrief-Popovich swan neck curl cath peritoneal catheters support a buried insertion technique, which has been shown to lessen the complications of peritoneal catheter insertion, including peritonitis, tunnel/cuff infections and leakage.

The Argyle™ Moncrief-Popovich swan neck curl cath peritoneal catheter features a larger 2.5cm subcutaneous cuff. This cuff allows the catheter to be inserted and left buried in the subcutaneous tissue for 3 to 6 weeks prior to use. This design in combination with the buried insertion technique has been shown to lessen the complications of peritoneal catheter insertion including peritonitis, tunnel/cuff infections and leakage by formation of an improved bacteriological barrier and maximum tissue ingrowth into the catheter cuffs in a sterile environment.

Order Information

Order CodeDescriptionUnit of MeasureQuantity
8888414029Swan Neck Moncrief-Popovich Swan Neck Curl Cath Catheter, 2 Cuff, 62.5 cmCarton5

Argyle™* Oreopoulos-Zellerman Missouri Tenckhoff Peritoneal Dialysis Catheter

Product Details

Argyle™ Oreopoulos-Zellerman Missouri Tenckhoff peritoneal catheters are designed to prevent omental wrapping and to keep the catheter placed low in the pelvis.

With the addition of two silicone discs in the internal catheter segment, Argyle™ Oreopoulos-Zellerman Missouri Tenckhoff peritoneal catheters prevent omental wrapping and keeps the catheter placed low in the pelvis. The Missouri configuration adds a silicone bead and a felt disc (flange). The felt disc is placed just outside the peritoneum and is sutured to the rectus muscle. The bead rests just inside the peritoneum to prevent dialysate leakage.

Order Information

Order CodeDescriptionUnit of MeasureQuantity
8888411009Oreopoulos-Zellerman Catheter, Missouri Catheter, 1 Bead, 2 Disks, 2 Cuffs, 41 cmCarton1

Argyle™* Curl Cath Peritoneal Dialysis Catheter

Product Details

The Argyle™ curl cath peritoneal catheter is designed to stay low in the pelvic gutter, resulting in less catheter migration.

A modified Tenckhoff catheter, the Argyle™ curl cath peritoneal catheter is suitable for acute or chronic peritoneal dialysis and intraperitoneal chemotherapy. It can be inserted either percutaneously or surgically. The additional mass of the Argyle™ curl cath peritoneal catheter keeps it low in the pelvic gutter, resulting in less catheter migration. The catheter’s curled tubing and numerous inflow/outflow holes diffuse dialysate gently into the patient.

Order Information

Order CodeDescriptionUnit of MeasureQuantity
8811313014Argyle™ Curl Cath Peritoneal Catheter, Curled, One Cuff,  57 cmCarton1
8811313013Argyle™ Curl Cath Peritoneal Catheter, Curled, One Cuff,  60 cmCarton1

Argyle™* Tenckhoff Peritoneal Dialysis Catheter

Product Details

Choose from a variety of catheter lengths and cuff placements and types, or select the Argyle™ universal Tenckhoff—a unique catheter that can be trimmed to fit most patient sizes.

Used for short-term and long-term peritoneal chemotherapy, the Argyle™ Tenckhoff catheter is a standard peritoneal catheter that comes in a variety of lengths and cuff configurations to include one (1) attached cuff or two (2) attached cuffs. Also available: the Argyle™ universal Tenckhoff, which is a unique catheter that can be trimmed to fit most patient sizes.

Order Information

Order CodeDescriptionUnit of MeasureQuantity
Argyle™ Tenckhoff Peritoneal Catheters — Two Cuffs
8810888003Argyle™ Tenckhoff Peritoneal  Catheter, 2 Cuff, 42 cmCarton1
8810888012Argyle™ Tenckhoff Peritoneal  Catheter, Universal, 2 Cuff, 47 cmCarton1
Argyle™ Tenckhoff Peritoneal Catheters — One Cuff
8814843001Argyle™ Tenckhoff Peritoneal  Catheter, 1 Preperitoneal Cuff, 41 cmCarton1
8814843002Argyle™ Tenckhoff Peritoneal  Catheter, Universal, 1 Preperitoneal Cuff, 46 cmCarton1
8810889003Argyle™ Tenckhoff Peritoneal  Catheter, 1 Subcutaneous Cuff, 42 cmCarton1
Источник: [https://torrent-igruha.org/3551-portal.html]

Techniques for Peritoneal Dialysis Catheter Placement

Open access peer-reviewed chapter

By Stephen Akau Kache, Danjuma Sale and Jerry Godfrey Makama

Submitted: October 3rd 2017Reviewed: February 13th 2018Published: August 1st 2018

DOI: 10.5772/intechopen.75355

Abstract

This chapter describes the peritoneal dialysis (PD) catheter implantation techniques. It will also discuss the merits and demerits of each technique, catheter types as well as the PD catheter-related complications. Several techniques and modifications have been described for the insertion of the catheter into the abdominal cavity. We will describe the currently available catheter designs which come in a variety of shapes (straight, pigtail-curled, swan-neck), length and number of Dacron cuffs for optimal ingrowth and fixation and insertion techniques with its early and late complications. These techniques include open surgical, laparoscopic and percutaneous techniques. The strategy for an optimal catheter implantation together with the preventive and therapeutic means for complicated treatment will be discussed.

Keywords

  • technique
  • peritoneal dialysis
  • catheter placement

chapter and author info

Authors

  • Stephen Akau Kache*

    • Department of Surgery, Barau Dikko Teaching Hospital, Kaduna State University, Kaduna, Nigeria
  • Danjuma Sale

    • Department of Surgery, Barau Dikko Teaching Hospital, Kaduna State University, Kaduna, Nigeria
  • Jerry Godfrey Makama

    • Department of Surgery, Barau Dikko Teaching Hospital, Kaduna State University, Kaduna, Nigeria

*Address all correspondence to: kachesteve@yahoo.com



DOI: 10.5772/intechopen.75355

From the Edited Volume

Evolving Strategies in Peritoneal Dialysis

Edited by Edward T. Zawada, Jr.

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1. Introduction

A well-placed and functioning peritoneal dialysis (PD) catheter is central to the success of peritoneal dialysis (PD) as a renal replacement therapy, therefore, knowledge of best practices in catheter insertion can minimise the risk of catheter complications that leads to peritoneal dialysis failure [1]. The first successful PD was done in 1959 by Richard Ruben, his patient survived for 6 months, by 1964, Fred Boen from the Netherlands used a machine he developed a year earlier to treat two patients with end-stage renal disease for 2 years [2, 3]. These initial successes with the PD were soon followed by descriptions of several techniques and modifications for catheter placement ranging from open surgical techniques, through percutaneous placement to later laparoscopic placement [2, 4, 5, 6, 7, 8].

Several advantages of PD over haemodialysis (HD) have been described, including the quality of life due to superior patient mobility and independence, its simplicity in use, along with the clinical advantages like the maintenance of residual renal function and lower mortality in the first years after the beginning of PD. A significant disadvantage is the poor blood pressure control due to fluid overload [9].

The aim of this chapter is to describe the currently available catheter types and insertion techniques.

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2. Technique for peritoneal dialysis catheter insertion

2.1. Types of peritoneal dialysis catheters

Peritoneal dialysis catheters come in various shapes (straight, pigtail-curled, swan-neck), lengths and numbers of Dacron cuffs (Figure 1). The peritoneal dialysis catheter is composed of a flexible silicone tube with an open-end port and several side holes to provide optimal drainage and absorption of the dialysate [2, 10].

The extraperitoneal component of the catheter has either one or two Dacron cuffs. The Dacron cuffs are for optimal growth and fixation. In adults, a double-cuff catheter is typically used. With the double-cuff peritoneal dialysis catheter, the proximal cuff is positioned in the preperitoneal space and the distal cuff in the subcutaneous tissue [2, 10]. The pubic symphysis has been recommended as a reliable marker for the ideal location of the catheter tip in the true pelvis [2] (Figure 2).

The proximal cuff holds the catheter in place while the distal cuff acts as a barrier to infection. The type of catheter selected is usually based on the surgeon’s preference.

2.1.1. Characteristic of an ideal peritoneal dialysis catheter

An ideal PD catheter should allow for optimal inflow and outflow and should be kink resistant; it should have no effect on physiology of abdominal tissues, should be resistant to infection with good surgical handling and should be affordable [10].

2.2. Techniques for insertion

There are several techniques used for the introduction of the PD catheter into the abdominal cavity. Open surgical and laparoscopic techniques are preferred because of their safety and good initial results [2]. The laparoscopic technique is becoming more popular because of its advantage in performing partial omentectomy, omentopexy or adhesionlysis during the initial catheter placement [2, 11, 12, 13, 14]. Percutaneous (radiological) catheter insertion may be less invasive but bears the risk of unsatisfactory catheter placement and danger of bowel perforation [2, 8].

2.2.1. Open surgical technique

With the patient placed in supine position under general anaesthesia, we routinely use an infraumbilical (two finger breaths) curvilinear incision on skin and subcutaneous tissue and a midline incision is then made on the fascia to gain access to the peritoneal cavity. However, Peppelenbosch et al. [2] described a technique in which a vertical incision of ∼5 cm is made in the midline, 2–3 cm below the umbilicus. The subcutaneous layer is then dissected, till the sheath of the rectal abdominal muscle is reached. The anterior rectus sheath is opened and the muscle fibres are bluntly dissected. Subsequently, the posterior sheath is cut to 3–4 cm and the abdominal cavity is opened after dissecting the peritoneum. The abdominal wall is inspected for adhesions. After this, a retractor is used to lift the anterior abdominal wall. If the adhesions are present close to the abdominal wall, they are dissected. The patient is placed in a Trendelenburg position and the catheter is placed over a stylet and advanced into the peritoneal cavity. The intraperitoneal segment is slid off the stylet and the cuff is advanced to the preperitoneal space. The peritoneum and rectus sheaths (posterior and anterior) are closed carefully with absorbable sutures, ensuring not to obstruct the catheter and to prevent dialysate leakage. A tunnel is created to the preferred exit site using a needle and care should be taken to ensure that the exit site is facing downwards. The distal cuff is placed subcutaneously, 2 cm from the exit site. The exit site is usually lateral and caudal to the entrance site (Figure 2). Haemostasis is secured, and the incision is closed and the catheter itself is not fixated with a suture. The functioning of the catheter is tested by filling the abdomen with 100 ml of saline and the entrance site is checked for leakage. The saline is allowed to drain and is inspected for evidence of haemoperitoneum and faecal contamination.

2.2.2. Percutaneous

Placement of PD catheters with a guide wire and peel-away sheath is performed using a Seldinger technique. The procedure can be performed under local or general anaesthesia with prophylactic antibiotics. A small incision is created above the entrance site, usually in the midline with blunt dissection of the abdominal rectus sheath. The peritoneal cavity is cannulated with an 18-gauge needle and filled with either air or 500 ml of saline. With proper needle placement, the patient should not experience pain or resistance to fill the cavity with fluid. A 0.035-inch guide wire is advanced into the abdomen and the introduction needle is removed. A dilator and the peel-away sheath are advanced over the wire into the abdominal cavity. The wire and the dilator are removed and the catheter is placed on the stylet, advanced through the sheath. The intraperitoneal segment is advanced until the proximal cuff is located in the preperitoneal space. The peel-away sheath and stylet are removed and the catheter position is checked. A tunnel is created to the selected exit site with the placement of the distal cuff subcutaneously, 2 cm from the exit site. The entrance site is closed. The abdomen is filled with 500 ml of saline and drained [2].

2.2.3. Laparoscopic technique

The patient is placed in the supine position. General anaesthesia is inducted and intravenous antibiotics are administered. It is preferable to create a pneumoperitoneum with an open procedure. A small subumbilical incision is made (2–3 cm) and the umbilical cord is grasped with forceps and lifted. Subsequently, the subcutaneous layer is transected. The anterior rectus sheath is opened and a suture is placed to lift the anterior sheath. The posterior sheath and subsequently the peritoneum are digitally opened. If adhesions are present close to the abdominal wall, they are transected. A 5 mm trocar or a screw trocar is inserted into the abdomen and insufflated with CO2 gas to create a pneumoperitoneum of 12–14 mmHg. A Veress needle technique can also be adopted. Several methods have been described. One is to place the needle in the upper-left quadrant of the abdomen. Another way is to open the anterior sheath as explained in the open procedure, but the Veress needle is used for the last one or two steps (the posterior sheath or the peritoneum). After the needle is in place, its correct position is tested by the water drop test, which should disappear into the abdomen through the needle and by insufflating and aspirating the 10 ml saline. After creating a pneumoperitoneum, a 5 mm trocar is inserted in the subumbilical position. After the 5 mm trocar is in place, the patient is placed in a Trendelenburg position and a diagnostic laparoscopy is performed with a 5 mm 0° scoop. In case the Veress needle is placed in the left-upper quadrant of the abdomen, its position is checked and the needle is removed. An extra 5 mm trocar is inserted under direct vision at the site of the planned exit-site position of the PD catheter (paraumbilical left or right 2–3 cm below the umbilicus). This trocar is introduced through the anterior and posterior rectus sheaths but not through the peritoneum. Under direct vision, the trocar is directed in the preperitoneal space, 2–4 cm downwards and to the midline of the abdomen. If adhesions are present, the trocar is introduced into the peritoneal cavity. Adhesions close to the abdominal wall are ligated with electrocoagulation or with the ligature device (US Surgical). A double-cuffed curled-tip PD catheter is then introduced through the paraumbilical port, ensuring no torsion has occurred, and is placed with the curled tip into the cavum douglasi. If no adhesions are present, then the second trocar is not introduced into the peritoneal cavity but is left in the preperitoneal space. Now, the stiff stylet is used to introduce the catheter into the peritoneal cavity. If the placement is troublesome, an extra 5 mm trocar is used, which can be inserted under the direct vision to grasp the catheter for proper positioning. The distal cuff of the PD catheter should be outside the peritoneum (in the preperitoneal space or between both the rectus sheaths). The paraumbilical trocar is removed and the catheter is now directed to its exit-site position. A needle is used to create the subcutaneous tunnel to the left or the right abdomen. The proximal cuff should be in this tunnel. The catheter is tested and then the abdomen is desufflated, with the camera still in position to check on the location of the catheter. The trocar is removed and the rectus sheaths are closed carefully with resorbable sutures. The wounds are closed with a resorbable monofilament suture, intracutaneously [2].

2.2.4. Alternative techniques

The Moncrief-Popovich catheter and technique involves subcutaneous burial of the external segment of the peritoneal dialysis catheter to prevent colonisation of the catheter by skin bacteria and to promote attachment of the cuff to the tissue prior to exteriorization. A reduction in the rate of peritonitis and colonisation of bacterial biofilms in the catheter segments between the two cuffs was noted with the Moncrief-Popovich catheter [15]; however, a controlled randomised study failed to confirm these results [16].

2.2.5. Extended dialysis catheters

Longer dialysis catheters have been developed to allow placement of the exit site in remote places such as the presternal area [17]. Such extended catheters may be useful in obese patients and in those with an abdominal stoma [18].

2.3. Complications

Complications after PD catheter placement are defined as those occurring early (<30 days) or late (>30 days), after surgery [2].

2.3.1. Early complications

2.3.1.1. Bowel perforation

The risk of bowel perforation is less than 1%, and it usually occurs during entry into the abdominal cavity or when the catheter and stylet are advanced into the abdomen. Surgical exploration is necessary with repair of the perforation and removal of the catheter [2].

2.3.1.2. Bleeding

Bleeding is rarely a significant problem after peritoneal dialysis catheter placement. When bleeding occurs, it is usually at the exit site.

2.3.1.3. Wound infection

Wound infection is uncommon and often can be treated with antibiotics when it is superficial. If the wound is deeper, then it may need to be drained.

Outflow failure may be due to

  1. Clots or fibrin in the catheter: an attempt to irrigate the catheter forcefully with saline or urokinase can be tried or a stiff wire can be inserted into the catheter under fluoroscopy.

  2. A kink in the subcutaneous tunnel: an incision is made directly over the kink and the catheter is repositioned.

  3. Placement of the catheter in the omentum.

  4. Occlusion from omentum or adhesions.

  5. Malpositioning of the catheter into the upper abdomen.

Laparoscopy is useful for identification and treatment of obstruction due to omentum or adhesions as well as for repositioning and fixation in the case of a malpositioned catheter [19]. The position of the catheter may also be identified on plain film or under fluoroscopy with the injection of contrast into the catheter and may be repositioned with a stiff guide wire or forceps [20].

Leakage of the dialysate may be identified by the presence of drainage at the exit site or the appearance of a bulge underneath the entrance site. Leaks may occur due to

  1. hernia at the entrance site

  2. positioning of the proximal cuff on the rectus muscle

  3. trauma

Withholding use of the peritoneal dialysis catheter for several weeks may solve the problem [21]. The use of a modified technique of peritoneal dialysis catheter insertion with fibrin glue has been shown to prevent pericatheter leakage [18, 22].

Peritonitis may occur early and manifests as abdominal pain associated with cloudy peritoneal fluid. The fluid should be cultured, and appropriate antibiotics should be administered [18].

2.3.2. Late complications

Late complications include exit-site infection, tunnel infection, cuff protrusion, outflow failure and dialysate leaks or hernias [2, 18].

2.3.2.1. Cuff extrusion or infection

Cuff extrusion or infection can occur when the exit site is placed directly beneath the belt line. Superficial cuffs placed close to the skin may extrude or become infected. In such situations, the catheter should be exchanged and a new exit site selected [2, 18].

2.3.2.2. Outflow failure

Outflow failure beyond 30 days may occur due to constipation and can be treated with laxatives.

2.3.2.3. Peritonitis

Peritonitis is often the result of contamination with skin bacteria, but it may also be due to gram-negative bacteria associated with diarrhoea or diverticulitis. Systemic or intraperitoneal antibiotics are administered, and the exchange volumes decrease. Usually, a peritoneal dialysis catheter-related peritonitis will resolve with proper antibiotic therapy. If the infection persists, catheter removal and use of haemodialysis for 4–6 weeks is sufficient for resolution of the peritonitis [18, 22]. There is a strong association between exit-site infections and subsequent peritonitis, with an increased risk up to 60 days after initial diagnosis [18, 23].

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3. Conclusion

The success of PD as a renal replacement therapy is dependent on the proper placement of the permanent PD catheters. A good knowledge of the implantation techniques and complications is very essential for a good outcome.

How to cite and reference

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Stephen Akau Kache, Danjuma Sale and Jerry Godfrey Makama (August 1st 2018). Techniques for Peritoneal Dialysis Catheter Placement, Evolving Strategies in Peritoneal Dialysis, Edward T. Zawada, Jr., IntechOpen, DOI: 10.5772/intechopen.75355. Available from:

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Curled Catheter, Peritoneal, 2 Cuffs, 57cm, EACH

BYD Care Single use disposable 3-ply surgical mask, ASTM level-2 ear loop

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Covidien # 8811313015 - Curled Catheter, Peritoneal, 2 Cuffs, 57cm, EACH

Product Description

Covidien 8811313015 - Curled Catheter, Peritoneal, 2 Cuffs, 57cm, EACH

The Argyle Curl Cath Peritoneal Catheter is designed to stay low in the pelvic gutter, resulting in less catheter migration.

Features

  • 15 Fr outer diameter.
  • Highly kink-resistant, silicone material.
  • Curled catheter segment.
  • Radiopaque stripe.
  • Felt cuffs.
  • Multiple catheter configurations.

Benefits

  1. Provides maximum internal diameter to allow for steady flow rates during peritoneal fill and drain times.
  2. Provides comfort for the patient by reducing the likelihood of skin abrasion at the exit site and not impeding patient mobility. It also reduces the risk of organ or intestinal damage during insertion or use.
  3. Employs additional weight to further prevent internal catheter migration and minimizes patient inflow discomfort sometimes experienced with Tenckhoff catheter designs.
  4. Allows for visualization and orientation of the catheter during placement and diagnostic imaging.
  5. Anchor the catheter subcutaneously and preperitoneally, establishing a natural infection barrier through tissue ingrowth.
  6. Available in catheters or kits to ensure the inserter always has the right tools for insertion in any setting (O.R. or I.R.).

FAQs

1. What is the French size?

2. What is the inner diameter?

3. What is the catheter material?

  • The Argyle Curl Cath Peritoneal Catheter is made of a highly kink-resistant, silicone that provides comfort for the patient by reducing the likelihood of skin abrasion at the exit site and not impeding patient mobility. The silicone also reduces the risk of organ or intestinal damage during insertion and use.

4. What function does the curl serve on the Argyle Curl Cath Peritoneal catheters?

  • The additional mass of the curl portion of the Argyle Curl Cath Peritoneal Catheter keeps it low in the pelvic gutter, resulting in less catheter migration. The catheters curled tubing and numerous inflow/outflow holes diffuse dialysate gently into the patient.

5. Can the Argyle Curl Cath Peritoneal catheters be placed via a modified Seldinger technique or laparoscopically?

  • Yes. The Argyle Curl Cath Peritoneal Catheter can be placed via a modified Seldinger technique or laparoscopically. For a percutaneous placement via a modified Seldinger technique, they can be placed using a 16Fr Argyle Pull-Apart Sheath/Introducer (Item #8815544010). If placing laparoscopically, the catheters are compatible with an Auto Suture Mini Step 7/8mm Cannula and Dilator (Autosuture - Covidien - part number MS101008).

6. How many cuffs do the Argyle Curl Cath Peritoneal catheters have?

  • Felt cuffs anchor the catheter subcutaneously and help establish a natural infection barrier through tissue ingrowth. To meet the varying needs of patient and physician, three cuff configurations are offered: 1) Two attached cuffsone subcutaneous and one preperitoneal; 2) One attached cuffin the preperitoneal position; and 3) Two loose cuffsthe clinician can customize cuff placement on the catheter to meet the needs of the patient. According to the products Instructions for Use, the preperitoneal cuff is anchored to the anterior rectus sheath, making a watertight seal to prevent leakage from the peritoneal cavity. The subcutaneous cuff is placed 2cm3cm from the catheter exit site, deep subcutaneously to avoid cuff infection or extrusion. Both cuffs serve to anchor the catheter via tissue ingrowth and serve as a barrier to infection.

Related Products

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Medtronic 8811313010 ARGYLE Peritoneal dialysis catheter Curled Catheter, 2 Cuffs, 62 cm. Price of each.

8811313010 CATH, CURL, 62CM, 2 CUFF Peritoneal Two Cuff Curl Curl Cath 62Cm 2 Cuff, 1/Each

ARGYLE ™* PERITONEAL DIALYSIS CATHETERS

Peritoneal dialysis catheters are intended to provide permanent access to the peritoneal cavity for patients to fill and drain their dialysate daily. Due to this daily, repetitive use, it’s important to customize the catheter exit site for each patient to help facilitate easy patient and caregiver management. Optimized catheter placement and exit sites can help promote patient compliance for proper maintenance and may help reduce potential complications due to difficult to manage catheters. The Argyle™* peritoneal dialysis catheter line includes a variety of catheter configurations designed to enable patient customization to support long-term access preservation and patency.

8811313010

Источник: [https://torrent-igruha.org/3551-portal.html]

Curl Cath Continuous Ambulatory Peritoneal Dialysis CAPD Catheter

- The Curl Cath Continuous Ambulatory Peritoneal Dialysis (CAPD) Catheter is designed to stay low in the pelvic gutter, resulting in less catheter migration

- The catheter has an outer diameter of 15 Fr

- It provides maximum internal diameter to allow for steady flow rates during peritoneal fill and drain times

- The catheter allows for comfort to the patient by reducing the likelihood of skin abrasion at the exit site and not impeding patient mobility

- It also reduces the risk of organ or intestinal damage during insertion or use

- The catheter features curled catheter segment which puts additional weight to further prevent internal catheter migration and minimizes patient inflow discomfort

- The radiopaque stripe allows for visualization and orientation of the catheter during placement and diagnostic imaging

- It is equipped with 2 felt cuffs which allows to fix the catheter subcutaneously and preperitoneally, establishing a natural infection barrier through tissue in growth

- The catheter is available in the lengths of 57 cm and 62 cm

Источник: [https://torrent-igruha.org/3551-portal.html]
curl catheter

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