Estudio comparativo entre catéteres peritoneales autoposicionantes y catéteres Tenckhoff en referencia a su desplazamiento intraperitoneal

Abstract

The advances made in the field of accesses in perito-neal dialysis raise questions that require discernment and a possible solution. One of the most common causes of mechanical problems is omental entrap-ment or constipation. Other factors that can affect correct functioning of a peritoneal dialysis catheter is the existence of adhesions and/or hernias in the abdominal area.In our peritoneal dialysis unit, self-locating and non-self-locating (Tenckhoff) catheters are used, and therefore we decided to carry out a study to compare the differences in their operating life. Our aim was to compare the differences concerning complications due to displacement and incorrect posi-tioning between the two types of catheter, and also to evaluate whether obesity, prior abdominal surgery and the time the catheter is in place are variable that affect correct functioning of the catheters.The sample studied comprised patients who are currently active on the peritoneal dialysis progra-mme in our unit. A total of 35 patients were studied. 60% had a self-locating catheter and 40% a Tenckhoff catheter. 37.4% of the patients had undergone abdominal and/or pelvic surgery. Only 28.57% were obese (with a Body Mass Index > 30) with an average weight of 72.8±18.9 Kg.The catheters were implanted using open surgery, local anaesthetic and sedation and therefore in on an ambulatory basis.Random numerical correlation was used for the choice of catheter. The Tenckhoff catheter is a silicon tube with multi-ple distal orifices and which can have a straight or threaded tip. It also has a Dacron cuff to prevent infections of the orifice The self-locating catheter has the same form as a Tenckhoff catheter but with a modification. At the distal tip it has an increased diameter of two centi-metres, which is the result of adding a 12-gramme weight made of a biocompatible material (tungsten) to favour the positioning of the catheter always in the lower part of the peritoneal cavity, avoiding malfunction due to displacement.To analyse the mechanical complications of both types of catheters we recorded the occasions on which a bowel evacuant (X-Prep) was used and in which surgical repositioning of the catheter had been necessary (using only a guidewire to re-position it and without the need for local anaesthetic).A data compilation sheet was drawn up on which all the variables were noted: sex, age, time on perito-neal dialysis, body mass index, number of displace-ments, prior abdominal operations, and according the results obtained statistical confirmation was obtained that self-locating catheters present fewer mechanical problems of catheter migration than Tenckhoff catheters.Although it can be seen that in obese patients there is greater tolerance to both types of catheter, with fewer complications. It was also observed that both catheters present more problems after one year following implan-tation, significantly after 24 months in place. This confirms to us the good placing of the catheters by the surgeon, as at the beginning of implantation there are fewer complications.The mechanical problems presented by both types of catheter have been overcome by administering X-Prep or by re-positioning. There was only one patient who required open surgery to change the catheter, which was self-locating, and it was observed that the problem was caused by the multiple adhe-sions the patient present without having previously undergone surgery in the abdominal area. This case has led us to consider that patients may present entrapment problems not just because of surgical operations, but also because of their physiolog This study did not compare pain in the two types of catheter. Another study could be carried out evaluating this variable, as the weight in the distal tip of the self-locating catheter could increase the sensation of pain experienced by patients.