Catheter type, placement and insertion techniques for preventing peritonitis in peritoneal dialysis patients

Strippoli, Giovanni F. M., Tong, Allison, Johnson, David W., Schena, Francesco Paolo and Craig, Jonathan C. (2004) Catheter type, placement and insertion techniques for preventing peritonitis in peritoneal dialysis patients. Cochrane Database of Systematic Reviews, 4: 1-54. doi:10.1002/14651858.CD004680.pub2

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Author Strippoli, Giovanni F. M.
Tong, Allison
Johnson, David W.
Schena, Francesco Paolo
Craig, Jonathan C.
Title Catheter type, placement and insertion techniques for preventing peritonitis in peritoneal dialysis patients
Journal name Cochrane Database of Systematic Reviews   Check publisher's open access policy
ISSN 1469-493X
Publication date 2004-01-01
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1002/14651858.CD004680.pub2
Open Access Status File (Publisher version)
Issue 4
Start page 1
End page 54
Total pages 54
Place of publication United Kingdom
Publisher John Wiley & Sons
Language eng
Subject 110312 Nephrology and Urology
11 Medical and Health Sciences
1103 Clinical Sciences
Formatted abstract
Background
As many as 15-50% of end-stage kidney disease patients are on peritoneal dialysis (PD), but peritonitis limits its more widespread use. Several PD catheter-related interventions have been purported to reduce the risk of peritonitis in PD.

Objectives
To evaluate the use of catheter-related interventions for the prevention of peritonitis in PD.

Search strategy
The Cochrane Renal Group's specialised register (June 2004), The Cochrane CENTRAL Register of Controlled Trials (The Cochrane Library Issue 2 2004), MEDLINE (1966-April 2004), EMBASE (1988-April 2004) and reference lists were searched without language restriction

Selection criteria
Trials comparing different catheter insertion techniques, catheter types, use of immobilisation techniques or different break in periods were included. Trials of different PD sets were excluded.

Data collection and analysis
Two reviewers independently assessed trial quality and extracted data. Statistical analyses were performed using a random effects model and the results expressed as risk ratio (RR) with 95% confidence intervals (CI).

Main results
Seventeen eligible trials (1089 patients) were identified, eight 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. There were no significant differences with laparoscopy compared with laparotomy for peritonitis, the peritonitis rate, exit-site/tunnel infection or catheter removal/replacement. Standard insertion with resting but no subcutaneous burying of the catheter versus implantation and subcutaneous burying was not associated with a significant reduction in peritonitis rate, exit-site/tunnel infection rate or all-cause mortality. Midline compared to lateral insertion showed no significant difference in the risk of peritonitis or exit-site/tunnel infection. There was no significant difference in the risk of peritonitis, peritonitis rate, exit-site/tunnel infection, exit-site/tunnel infection rate or catheter removal/replacement between straight versus coiled intraperitoneal portion catheters. One trial compared single versus double cuffed catheters and showed no significant difference in the risk of peritonitis, exit-site/tunnel infection or catheter removal/replacement. One trial compared immobilisation versus no immobilisation of the PD catheter and showed no significant difference in the risk of peritonitis and exit-site/tunnel infection. No trials of different break-in periods were identified.

Authors' conclusions
No major advantages from any of the catheter-related interventions which have been purported to reduce the risk of PD peritonitis could be demonstrated in this review. The frequency and quality of available trials are suboptimal.
Keyword Catheterization - methods
Catheters, Indwelling
Peritoneal Dialysis - instrumentation
Peritonitis - prevention & control
Randomized Controlled Trials as Topic
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown
Additional Notes This version first published online: 18 October 2004 in Issue 4, 2004. Pages CD004680.

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
 
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Created: Mon, 06 Jul 2009, 19:48:24 EST by Maria Campbell on behalf of Faculty Of Health Sciences