T-fluted peritoneal dialysis catheter.

While the current Tenckhoff catheter is generally successful, outflow failure due to omental obstruction, pericatheter hernias, pericatheter leaks, and exit infections remains a major cause for dropout from peritoneal dialysis therapy. Further, the irregular outflow characteristics of the catheter make highflow automated dialysis problematic. We have developed a catheter with a thin transabdominal tube connecting in a T-shape to a transverse cylinder resting against the parietal peritoneum, with flutes (grooves) as ports. The catheter can be inserted through the 3-mm diameter Quill guide of the Y-TEC peritoneoscopic system. Studies in normal dogs indicated that the T-fluted catheter allowed daily exchanges with 2 L of peritoneal dialysate without outflow obstruction, and peritoneoscopic inspection 2-4 weeks later showed no omental attachment to the grooved ports. By comparison, curled Tenckhoff catheters uniformly developed omental obstruction within 2-4 days, and all such catheters had firm omental attachment to the side holes. Five T-fluted catheters have been placed in continuous ambulatory peritoneal dialysis (CAPD) patients who had prior complications with Tenckhoff catheters (infections, leaks, and outflow failure). One patient with multiple intraperitoneal adhesions developed outflow failure of the T-fluted catheter, similar to a prior Tenckhoff catheter. All other T-fluted catheters had consistent outflow rates and no complications. In long-term use the T-fluted catheter should prevent omental attachment, deep cuff extrusion, pericatheter hernias, subcutaneous cuff erosion, and exit-site infection, although this is not yet proven.