PD catheters: evolution towards optimal design


The first peritoneal accesses were devices that had been used in other fields (general surgery, urology, or gynecology) for flush or irrigate: trocars, rubber catheters, and sump drains. The majority of cases were treated with the continuous flow technique; rubber catheters tor inflow and sump drains for outflow were commonly used. These early devices, used for short-term peritoneal dialysis, were plagued with multiple complications, such as pressure on intestines of rigid tubes, plugging of openings, leakage of fluid around the access, and difficulties in fixation of the tube on the abdominal wall. In the late 1940s, after World War II, multiple peritoneal accesses were tried, and first accesses specifically tor peritoneal dialysis were designed. In the 1950s and particularly 1960s new access features solved most of the problems and eliminated most complications of peritoneal dialysis performed in the supine position. The invention of silicone rubber catheter with polyester cuff(s) was a greatest breakthrough in peritoneal dialysis access development. Unfortunately, none of the currently used catheters is trouble free; poor dialysate drainage, pericatheter leaks, exit site and tunnel infections, and recurrent peritonitis episodes are frequently encountered. Therefore, there is an incessant search for new technological solutions, including new shapes of intraperitoneal and intramural catheter segments, and new catheter materials are tried.

Keywords: Peritoneal access, Abdominal drains, Cannulas, Catheters, Peritoneal lavage, Peritoneal irrigation, Peritoneal dialysis.

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