The Ash Advantage is a T-shaped peritoneal
catheter with a single transabdominal tube joining to a tube lying against the parietal peritoneum. Segments with long flutes (grooves) serve as fluid ports rather than 1-mm diameter holes. The folded
catheter is placed through the expandable Y-TEC Quill positioned peritoneoscopically, similar to the procedure for a conventional Tenckhoff
catheter. In a clinical study, we placed 18 Ash Advantage ("Advantage")
catheters, 8 in patients with prior hydraulic or infectious complications of Tenckhoff
catheters and 10 in patients initiating
peritoneal dialysis. Mean follow-up has been 8.4 months. Outflow rate for the Advantage
catheters is uniformly higher than for Tenckhoff
catheters at 220 +/- 100 mL/min for the first 5 minutes and 145 +/- 72 mL/min for the next 5 minutes, with outflow completed in 6 to 15 minutes. Variation of outflow volumes for similar exchanges in the same patient is +/- 3% to 5%, much less than with Tenckhoff
catheters. Four
catheters failed after placement, each for a different reason including outflow failure because of preexisting intraperitoneal adhesions, preexisting
peritonitis failing to clear, tubing kink during placement, and
catheter break after a freak accident. Life-table analysis of the production version of the
catheter in study patients and 12 additional unselected patients indicates a 90% survival at 12 months. In long-term use, the fixed position of the cuffs of this
catheter may avoid
catheter extrusion, pericatheter
hernias, and pericatheter leaks. Multiple fluted ports appear to diminish omental attachment. The
catheter may be a useful alternative to conventional Tenckhoff
catheters in patients at high risk of
catheter failure or in standard
peritoneal dialysis patients.