Catheter-related interventions for preventing peritonitis in peritoneal dialysis

There is probably no major benefit from any catheter-related interventions which have been purported to reduce the risk of peritonitis in peritoneal dialysis patients.

A Cochrane review included 17 studies with a total of 1 089 subjects (eight studies of surgical strategies of catheter insertion, eight of straight versus coiled catheters, one of single cuff versus double cuff catheters and one of an immobiliser device). The methodological quality was suboptimal.

The main complications studied included peritonitis rate, exit-site/tunnel infection and catheter removal/replacement. There were no significant differences with laparoscopy compared with laparotomy; standard insertion with resting but no subcutaneous burying of the catheter versus implantation and subcutaneous burying; midline compared to lateral insertion; between straight versus coiled intraperitoneal portion catheters; single versus double cuffed catheters; or immobilisation versus no immobilisation of the PD catheter.

Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison) and by limitations in study quality (inadequate or unclear allocation concealment, lack of blinding, inadequate intention-to-treat adherence).

Ədəbiyyat

1. Strippoli GF, Tong A, Johnson D, Schena FP, Craig JC. Catheter type, placement and insertion techniques for preventing peritonitis in peritoneal dialysis patients. Cochrane Database Syst Rev 2004 Oct 18;(4):CD004680.