Moncrief J W, Popovich R P, Broadrick L J, He Z Z, Simmons E E, Tate R A
Austin Diagnostic Clinic, Texas.
ASAIO J. 1993 Jan-Mar;39(1):62-5.
Existing catheter implantation techniques violate a fundamental premise of wound healing. The immediate presence of the catheter in the post operative surgical wound forms a passage for permanent colonization of the catheter tunnel and cuff(s). This is manifested by the almost universal presence of the biologic products of bacterial growth (biofilm) on the external and internal surfaces of these catheters. The Moncrief-Popovich catheter and implantation technique are designed to address this problem. The Moncrief-Popovich catheter is implanted in the standard fashion, except that the external segment of the catheter is buried subcutaneously at the time of implantation. After allowing 3-5 weeks for tissue in-growth in a sterile environment, a small incision is made in the skin through which the external segment of the catheter is exteriorized and attached to an adapter. A 2 year trial was conducted in 59 patients, comprising 530 patient-months of experience; the incidence of peritonitis was one episode for every 29.4 patient months. All but three of the patients used the standard spike exchange technique. In a recently initiated study using disconnect procedures in 63 of the 74 patients studied, the peritonitis rate was one episode for every 28.7 patient-months; patient-months have totalled 201.2 to date. There was a rate of one exit site infection every 12.57 patients-months. It was concluded that the Moncrief-Popovich catheter and implantation technique result in a substantial decrease in the incidence of peritonitis for patients using the standard spike exchange system.
现有的导管植入技术违背了伤口愈合的一个基本前提。导管在术后手术伤口中的即时存在为导管隧道和袖带的永久定植形成了一条通道。这表现为这些导管的内外表面几乎普遍存在细菌生长的生物产物（生物膜）。蒙克里夫 - 波波维奇导管及植入技术旨在解决这一问题。蒙克里夫 - 波波维奇导管以标准方式植入，只是在植入时将导管的外部段皮下埋置。在无菌环境中让组织向内生长3 - 5周后，在皮肤上做一个小切口，通过该切口将导管的外部段引出并连接到一个转接器上。对59名患者进行了为期2年的试验，积累了530个患者月的经验；腹膜炎的发生率为每29.4个患者月发生1次。除3名患者外，所有患者都采用了标准的接头更换技术。在最近对74名研究患者中的63名采用断开连接程序启动的一项研究中，腹膜炎发生率为每28.7个患者月发生1次；迄今为止患者月总数已达201.2。出口部位感染率为每12.57个患者月发生1次。得出的结论是，对于使用标准接头更换系统的患者，蒙克里夫 - 波波维奇导管及植入技术可使腹膜炎的发生率大幅降低。
