Suggestions for Clinical Care

There are a number of variations on the standard singleor double-cuff Tenckhoff catheter that are now available which have been developed in an attempt to improve both the infectious complications, such as peritonitis and ESIs, and mechanical complications, such as flow problems and tip malposition. These variants include a coiled-tip Tenckhoff, Toronto Western Hospital catheter with silicone discs perpendicular to the catheter along the intraperitoneal segment, the LifecathTM catheter with a disc positioned on the parietal peritoneal surface, the T-fluted (Ash Advantage) catheter with a T-shaped intraperitoneal segment, the swan neck, with an inverted U shaped arc, the Moncrief-Popovich which is similar to the swan neck but has a longer external skin cuff of 2.5 cm, the pail handle catheter (Cruz), which has 2 right angle bends and small cuffs for peritoneoscopic insertion, the swan neck presternal catheter (Missouri), the Twardowski, which is composed of 2 silicone rubber tubes that are connected with a titanium connector at implantation with a coil and a longer subcutaneous tunnel, and the de Paolo self-locating catheter which is similar to a classic Tenckhoff with a 12 g tungsten weight at the internal tip, and is used widely in Italy and elsewhere.