Upward-directed exit-site of the swan-neck catheter and “Easy-to-disinfect the backside area of exit-site” may prevent PD complications

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-s...

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Published inClinical and experimental nephrology Vol. 28; no. 6; pp. 547 - 556
Main Authors Ogawa, Kyohei, Ikeda, Masato, Shirai, Izumi, Ohshiro, Kentaro, Maruyama, Yukio, Yokoo, Takashi, Tanno, Yudo, Terawaki, Hiroyuki, Sakurada, Tsutomu, Yoshikawa, Kazuhiro, Inoue, Hironobu, Higuchi, Chieko, Kaneko, Tomohiro, Nogaki, Fumiaki, Ueda, Atsushi, Maeda, Yoshitaka
Format Journal Article
LanguageEnglish
Published Singapore Springer Nature Singapore 01.06.2024
Springer Nature B.V
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Summary: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.
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ISSN:1342-1751
1437-7799
1437-7799
DOI:10.1007/s10157-023-02454-7