Catheter complications associated with implantable systems for peritoneal XXXX delivery. An analysis of frequency, predisposing factors, and obstructing materials.

@entity1 @entity691 @entity1212 @entity527 @entity6 @entity2690 @entity3885 @entity1346
OBJECTIVE: To evaluate @entity1212 survival and identify mechanisms involved in @entity1212 @entity3885 during a 109.8 @entity1 -year experience with implanted pumps for peritoneal @entity2690 delivery. RESEARCH DESIGN AND METHODS: Fifty-one type I @entity6 @entity1 were recruited in feasibility studies of two models of implanted systems for peritoneal @entity2690 delivery. Both systems had a @entity1346 -coated @entity691 @entity1212 and infused Hoechst 21 PH neutral @entity2690 (U400 or U100). Catheter obstruction was suspected each time the increase of @entity2690 flow rate over 50% of usual need was insufficient to correct an impairment of glycemic control in the absence of of intercurrent factors. A laparoscopic examination was then systematically performed under general anesthesia. The disclosed material occluding the @entity1212 was submitted to a pathological analysis. By actuarial analysis, we examined the estimated effects of the potential determinants of the catheters' duration of proper operation on @entity1212 survival. RESULTS: Over an implantation duration of 25.8 +/- 14.0 months (mean +/- SD), 34 @entity1212 @entity3885 were diagnosed in 24 @entity1 , resulting in an incidence of 31 events per 100 @entity1 -years. Fifty percent survival rate of the first implanted @entity1212 was 27 months (95% confidence interval [CI]: 19-32) on actuarial analysis. Six catheters were cleared under laparoscopy and 24 were replaced, while 2 systems were definitively explanted and 2 combined replacements of pump and @entity1212 were performed because of an associated pump slowdown. In five cases, an alkaline rinse procedure of the pump was necessary after @entity1212 replacement to restore usual @entity2690 needs, suggesting an associated @entity2690 aggregation in the pump. Twenty @entity3885 were due to a fibrin clot at the @entity1212 tip, and 14 @entity3885 were created by a tissue encapsulation around the @entity1212 . A previous experience of peritoneal @entity2690 infusion from portable pumps or a longer duration of @entity6 ( > 21 years) both appeared as conditions significantly reducing the time of a @entity1212 's proper operation (P < 0.01 and P < 0.05, respectively) either by @entity3885 or by encapsulations. Pathological analysis of @entity1212 encapsulations showed a collagen fibrosis in all studied @entity1 (n = 11), which was associated with a lymphocytic infiltrate in five @entity1 and also with anti- @entity2690 immunoreactive @entity527 in four @entity1 . Catheter tip clots were composed of fibrinlike material, nonreactive to anti- @entity2690 antibodies. CONCLUSIONS: Catheter obstruction is a frequent adverse technical event occurring with implanted @entity2690 pumps. Progress is expected in the biocompatibility of @entity1212 material and more specifically in the stability of @entity2690 preparations to prevent immuno-inflammatory reactions and @entity2690 @entity527 that appear to be involved in @entity1212 failures.
