Preliminary results with the Swan neck presternal catheter for CAPD in children.

Exit-site infection (ESI) in children on continuous ambulatory peritoneal dialysis (CAPD) is a complication observed mainly in obese patients and patients wearing diapers. From 15 December 1991 to 28 February 1993, five Swan neck presternal catheters (SNPCs) were implanted in 5 children aged 2-11 years. The criteria for insertion of a SNPC were the following: young age in 1 child, obesity in 2, recurrent ESI in 2, and the use of diapers in 2. In some patients there was more than one criterion. The observation period ranged from 1-10 months, and the time on CAPD with the SNPC was 1-9 months. During this period, we did not observe any catheter-related problems. The potential advantages of the chest location of the catheter exit site are the following: 1. easy exit-site care; 2. decreased risk of ESI in small children because of greater distance from wet diapers; 3. avoidance of trauma with crawling/creeping; and 4. better healing and decreased risk of ESI in the area with less fat thickness.