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Upward-directed exit-site of the swan-neck catheter and “Easy-to-disinfect the backside area of exit-site” may prevent PD complications
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Journal Article
Upward-directed exit-site of the swan-neck catheter and “Easy-to-disinfect the backside area of exit-site” may prevent PD complications
2024
Overview
Background
Upward-directed exit-site has been believed to be the worst for frequent ESI by an old retrospective study using straight catheters. No comparison study of 3 exit-site directions using swan-neck catheter has been performed regarding which direction is the best for our endpoints, Easy-to-see the backside area of exit-site: ESBE, Easy-to-disinfect the backside area of exit-site: EDBE, reduction of both exit-site infection (ESI), symptomatic catheter dislocation and peritonitis.
Methods
We assessed the relationship of exit-site direction with our endpoints in a quantitative cross-sectional, multicentered questionnaire survey. Patients who received either non-surgical catheter implantation or exit-site surgery were excluded.
Results
The numbers (percentage) of exit-site directions in included 291 patients were upward 79 (26.0), lateralward 108 (37.5) and downward 105 (36.5). Cochran-Armitage analysis showed a significant step-ladder increase in the prevalence of ESI as the direction changed from upward to lateralward to downward (0.15 ± 0.41, 0.25 ± 0.54, 0.38 ± 0.69 episodes/patient-year,
p
= 0.03). Multivariable regression analysis revealed the upward exit-site independently associates with both higher frequency of ESBE (OR 5.55, 95% CI 2.23–16.45,
p
< 0.01) and reduction of prevalence of ESI (OR 0.55, 95%CI 0.27–0.98,
p
= 0.04). Positive association between the prevalence of symptomatic catheter dislocation and ESI (OR 2.84, 95% CI 1.27–7.82,
p
= 0.01), and inverse association between EDBE and either prevalence of symptomatic catheter dislocation (OR 0.27, 95% CI 0.11–0.72) or peritonitis (OR 0.48, 95% CI 0.23–0.99) observed.
Conclusion
Upward-directed swan-neck catheter exit-site may be the best for both ESBE and prevention of ESI. EDBE may reduce catheter dislocation and peritonitis. Symptomatic catheter dislocation may predict ESI.
Publisher
Springer Science and Business Media LLC,Springer Nature Singapore,Springer Nature B.V
Subject
