Discussion board


Zbylut J. Twardowski, MD, PhD, FACP

Professor of Medicine Emeritus. Division of Nephrology. Department of Medicine. University of Missouri.
Columbia, Missouri.



El Nov 16, 2001 9:35 pm, Pedro dijo:

Do you think that using vancomycin as a prophilactic therapy could favour
strains of enterococus and staphilococcus resistance

El Nov 16, 2001 9:37 pm, Pedro dijo:

What do you think about selfpositionated catheter?

El Nov 16, 2001 9:38 pm, Maria Jesus Coma dijo:

Have you experience with tungsten catheter, known as "dr di paolo catheter" ?

El Nov 16, 2001 10:07 pm, Twardowski dijo:

Dear Dr. Pedro

The risk is very low, but obviously exists. Using any prophylactic antibiotic is associated with such a risk. On the other hand without prophylactic antibiotics the rate of catheter infections is higher.
It is worth noting that plastic surgeons, dentists, orthopedic surgeons,general surgeons, and others use prophylactic antibiotics routinely. Why only PD patients may be sacrificed for others?

Zbylut J. twardowski

El Nov 16, 2001 10:17 pm, Twardowski dijo:

I have never used "self positioning" catheter. This kind of catheter is supposed to prevent only one complication - migration. I read the first paper on this cathetr and the rate of migrations was markedly lower that the rate of migrations of Tenckhoff catheters; however, the rate of migrations of Tenckfohff catheters in that series was unusually high. I have never had such a high rate of migrations.I do not feel that we need to switch from swan neck catheters.
Teh rate of migrations of swan neck catheters in general, including presternal catheters is extremely low. None of the swan neck presternal catheters was removed due to migration.
The reason of this low migration rate is related to the proper direction of the catheter tip and slanted flange. The theory of this problem was discussed in detail in :

Twardowski ZJ, Nichols WK: Peritoneal dialysis access and exit site care including surgical aspects. In: Peritoneal Dialysis. Edited by Gokal R, Khanna R, Krediet RT, Nolph KD. Kluwer Academic Publishers, Dordrecht/Boston/London, Second Edition, 2000 (Chapter 9): 307 - 361.

El Nov 16, 2001 10:34 pm, Twardowski dijo:

Dear Dr. Maria Jesus Coma,

See my above response to Dr. Pedro. I will add some more comments.
As I am aware the first paper on "self-locating" peritoneal catheter was publishe in 1995 or 1996. As I remember the paper was published in PDI. What struck me at that time that they had something like 9 or 10 dislocations in 25 or 30 catheters, the rate we had never had with Tenckhoff catheters. Compared to Tenckhoff catheters they did not note any significant differences in cuff extrusions, exit-site infections, and leakages.The only other publication on this catheter by Cavagna et al. in PDI in 1999 found the same. Only decreased catheter migrations with remaining complications unchanged.
Swan neck presternal catheter is designed to decrease rates of all these complications; therefore, the catheter survival probability is markedly higher than reported for any other catheter.

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