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      A Prospective Study to Compare Subcutaneously Buried Peritoneal Dialysis Catheter Technique with Conventional Technique

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          Abstract

          Aims: To reduce peritoneal dialysis-related infections, Moncrief-Popovich (MP) designed a special catheter and implantation technique. Herein we report our experience of patients treated with the MP and conventional approach. Methods: A total of 214 patients were divided into three groups according to catheter type and implantation technique: group A received a MP catheter (MPC) via MP technique (n = 27); group B received Tenckhoff catheters via MP technique (n = 32), and group C received Tenckhoff catheters via conventional technique (n = 155). Data were collected for infection and catheter survival. Results: The catheter survival and peritonitis rate was similar in our study groups. Age was found to be the significant factor associated with peritonitis rate. Conclusions: Although the MP technique was not associated with a lower peritonitis rate in our practice, the possible benefit of less healthcare costs is still considerable.

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          Most cited references7

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          Effect of Prolonged Subcutaneous Implantation of Peritoneal Catheter on Peritonitis Rate during CAPD: A Prospective Randomized Study

          We conducted a prospective randomized controlled study to confirm our earlier observation that prolonged subcutaneous implantation of peritoneal catheter reduced peritonitis rate when compared to retrospective data from patients with catheters placed by conventional access technique. A total of 60 patients were randomized into two groups: 30 patients had catheters left implanted subcutaneously for 6 weeks (I) and the other 30 patients had catheters inserted by conventional technique and had 6 weeks of break-in period (C). Subgroups of 15 patients each with new and conventional techniques used Y-connector (IY, CY) and remaining patients used standard spikes (IS, CS).Mean age was 47.7 years (range 16–71); 61.0% were male and 44.1% diabetics. Peritonitis, exit site infection, simultaneous peritonitis and exit site infection, and complication related to Staphylococcus or Pseudomonas infections were observed for up to 2 years in each patient after initiation of bag exchange or until termination of CAPD by transfer to hemodialysis or by death.Total duration of observation was 493.2 patient-months for new access technique and 409.6 patient-months for conventional technique. Patients in IY group had the lowest incidence of peritonitis (1/14.9 patient-months) and exit site infection (1/16.8 patient-months) among four subgroups. Peritonitis rate in IY was significantly lower compared to CY or CS. The total peritonitis-free period in those patients who did not experience peritonitis during the observation period was also significantly longer in IY (120 patient-months) than in CY (26 patient-months), IS (10.6 patient-months), or CS (10.4 patient-months). Simultaneous peritonitis and exit site infection was observed in none of IY group but 3 episodes in CY, 4 episodes in IS, and 3 episodes in CS. The rates of complications related to Staphylococcus aureus and Pseudomonas infections were also significantly lower in IY than in CY, IS, or CS. Technique survival did not differ between the two groups.The present results confirm our previous observation that the new access technique reduces the incidence of peritonitis probably by reducing infection via periluminal route. The Y-connector system further reduces peritonitis rate by reducing infection via intraluminal route.
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            Initial subcutaneous embedding of the peritoneal dialysis catheter-a critical appraisal of this new implantation technique

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              Modelling peritonitis rates and associated risk factors for individuals on continuous ambulatory peritoneal dialysis.

              E F Vonesh (1990)
              A mixed effects Poisson regression model is proposed for analysing potential risk factors associated with peritonitis, a bacterial infection of the peritoneum which is common among individuals on continuous ambulatory peritoneal dialysis (CAPD). The model incorporates a set of fixed effects corresponding to concomitant information collected across individuals as well as a random effect due to individuals. The method of maximum likelihood is used to estimate the unknown parameters. When applied to clinical data obtained on 81 CAPD patients from four centres, the mixed effects model demonstrated a much better fit than the corresponding fixed effects Poisson regression model.
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                Author and article information

                Journal
                BPU
                Blood Purif
                10.1159/issn.0253-5068
                Blood Purification
                S. Karger AG
                0253-5068
                1421-9735
                2007
                July 2007
                23 March 2007
                : 25
                : 3
                : 229-232
                Affiliations
                aDepartment of Nephrology, E-Da Hospital, Kaohsiung, bDepartment of Statistics, National Cheng-Kung University, and cDepartment of Nephrology, Wu Ho-Su Memorial Hospital, Taipei, Taiwan
                Article
                101027 Blood Purif 2007;25:229–232
                10.1159/000101027
                17384502
                e6fdbaf2-a8c8-4c42-ae24-d58efe2496c3
                © 2007 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 09 November 2005
                : 01 December 2007
                Page count
                Figures: 1, Tables: 4, References: 13, Pages: 4
                Categories
                Original Paper

                Cardiovascular Medicine,Nephrology
                Subcutaneously buried PD catheter technique,Peritonitis,Peritoneal dialysis,Moncrief-Popovich catheter

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