Six-Year Experience with CAPD Catheters in Children

Abstract

Over a six-year period, 78 chronic peritoneal catheters were implanted in 55 patients; mean age at insertion was 9.6 years (range 0.2 to 19.1 years) and mean body weight was 28.3 kg (range 4.5 to 63 kg). Singlecuff catheters were used almost exclusively and were inserted in the midline under general anesthetic. Complications included leakage (26%) and one-way catheter obstruction (17%). Exit site and/or tunnel infections developed in 25% and hernias in 20% of 55 patients. Twenty-six catheters required replacement or removal. Actuarial catheter survival was 50% at two years. A retrospective analysis of exit-site infections suggested a significant benefit with “covered” as opposed to “uncovered” catheters (p < 0.01). Despite difficulties with catheter function only one patient was taken off CAPD because of a leak into the pleural cavity. Recent experience suggests that paramedian catheter placement and the use of catheters of an appropriate length for children will reduce the incidence of leakage and one-way obstruction. The complications associated with implantation and the long-term use of chronic peritoneal catheters have produced several modifications of the original Tenckhoff catheter (1–4). However, it remains to be established whether single or double cuff catheters result in fewer exit site, tunnel, or peritoneal complications (5). When our program started in 1978, we used double-cuff catheters but subsequently have implanted single-cuff catheters almost exclusively. Our initial experience with exit-site and tunnel infections was encouraging: only one out of 37 catheters had to be replaced because of tunnel infection (6). This paper describes our additional experience and the complications encountered with increasing duration of catheter use in our pediatric population.