Implantation of Presternal Catheter Using Moncrief Technique: Aiming for Fewer Catheter-Related Complications

♦ Objectives To reduce catheter-related complications, we developed a new technique of catheter implantation, combining a presternal catheter with the Moncrief technique.♦ Methods The presternal catheter, consisting of 2 catheters joined by a titanium extender, was surgically implanted. Its end was left embedded in the presternal wall. A few weeks after implantation, the embedded subcutaneous catheter was exteriorized, exiting in the 4th intercostal space, and peritoneal dialysis (PD) was commenced.♦ Results Using the new technique, 9 catheters were implanted (3 in women and 6 in men). Exteriorization was performed 30.6 ± 14.3 days after implantation of the catheter. Total observation period was 70 patient–months. Average hospitalization was 4.4 ± 1.3 days for catheter implantation, and 2.6 ± 2.6 days for exteriorization. Peritoneal dialysis commenced on the day of exteriorization with an exchange volume of 1.8 ± 0.3 L, using 4 exchanges daily. During the observation period, none of the patients experienced a catheter infection or dialysate leak. One non infectious complication was observed (a catheter wrapped in omentum).♦ Conclusions Our approach of combining a presternal catheter and the Moncrief technique had some advantages not only in regard to catheter infection and dialysate leakage, but also in regard to quality of life and hospitalization for the patient.