A salvage technique for continuous ambulatory peritoneal dialysis catheters with exit-site infections

Cheung, Alan H. S.; Wheeler, Mary S.; Limm, Whitney; Wong, Linda L.; Fan, Fong-Liang; Wong, Livingston

doi:10.1016/s0002-9610(99)80253-0

Cited by 22 publications

(16 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The un-roofing technique, with or without en bloc resection of the skin and tissues around the peripheral cuff, has been advocated but is associated with considerable risk of peritonitis (203–207). In contrast, observational data suggest that partial catheter re-implantation (200) and catheter diversion procedure with exit-site renewal (208–213) could be considered for catheter salvage. The latter technique has been extensively reported as an alternative to catheter removal for refractory exit-site or tunnel infections, although no randomized controlled trial has been completed.…”

Section: Other Catheter Interventionsmentioning

confidence: 99%

ISPD Catheter-Related Infection Recommendations: 2017 Update

et al. 2017

View full text Add to dashboard Cite

Section: Other Catheter Interventionsmentioning

confidence: 99%

ISPD Catheter-Related Infection Recommendations: 2017 Update

et al. 2017

View full text Add to dashboard Cite

“…Catheter leakage might induce peritonitis if not treated properly. Although some prefer to replace the leaking segment with an adapting catheter, 19 we believe that replacing the leaking catheter with a new catheter is an easier alternative.…”

Section: Discussionmentioning

confidence: 95%

“…Most exit site and tunnel infections resistant to medical treatment are initially treated with surgical debridement. Cheung et al 19 . described a salvage technique to treat the exit site infection.…”

Section: Discussionmentioning

confidence: 99%

Second surgical procedures for continuous ambulatory peritoneal dialysis patients: An analysis of 148 cases

2011

View full text Add to dashboard Cite

Aim:Patients who undergo continuous ambulatory peritoneal dialysis (CAPD) frequently need second surgical procedures (SSP) for various reasons. After 18 years of practice and observation, we analysed the records of these patients and tried to determine what complications occurred most often and how to deal with them. Patients and methods: We retrospectively reviewed the medical records of patients receiving CAPD treatment in the past 18 years at our hospital. The impact of the most serious complications to the CAPD modality was presented by the technique survival rate. We also classified the SSP and analysed the indications for SSP. Results: All 206 SSP could be classified into 12 types of procedures. More than half of the procedures (51.9 per cent) were catheter removal, followed by debridement (14.1 per cent) and herniorrhaphy (10.2 per cent). There were 18 indications for SSP. The most common indication was peritonitis (21.4 per cent). The 3-year technique survival was only 23.2 per cent in 82 patients whose catheters were removed because of serious complications. Conclusions: During our long-term follow up of CAPD patients, more than one-third (36 per cent) needed SSP. Catheter removal forced by peritonitis still remains a major problem for patients and care providers. Technique survival was very low once a serious complication occurred.

show abstract

“…For refractory ESIs, current guidelines suggest the timely replacement of the entire catheter, as this can prevent the inward dissemination of the infection, with the added advantage of permitting simultaneous replacement, thus avoiding prolonged periods on hemodialysis (4–7). Alternatively, the replacement of the infected external tubing segment by catheter splicing (8–11), or unroofing of the tunnel tract and shaving/removal of the superficial catheter cuff (12 13 14 15 16 17 18-19) have been proposed. On the contrary, our method is based on the assumption that the removal of the superficial cuff rather than the entire catheter is adequate to eradicate the infection since it is known to be an ongoing reservoir of infection.…”

Section: Discussionmentioning

confidence: 99%

Exit-Site Relocation: A Novel, Straightforward Technique for Exit-Site Infections

et al. 2019

View full text Add to dashboard Cite

Background Exit-site infection (ESI) and tunnel infection (TI) of the peritoneal dialysis (PD) catheter are significant causes of catheter or even method loss as well as patient morbidity. Among the methods that have been in use thus far, the removal and replacement of the catheter often needs to be followed by switching temporarily to hemodialysis, whereas catheter splicing or unroofing of the tunnel tract and shaving/removal of the superficial catheter cuff have not gained universal acceptance thus far. Methods We treat chronic ESI with exit-site relocation under local anesthetic with removal of the external cuff. For the purposes of this study, we conducted a retrospective cohort analysis of all exit-site relocations performed using that technique over a 5-year period. Results Twenty-seven patients (16 male, mean age 58 years, range 23 – 81 years) with chronic ESI underwent exit-site relocation under local anesthetic as a day-case procedure. Follow-up was 47.5 ± 22.4 months (range 10.8 – 79.4 months). No dialysate leaks occurred following the procedure. Peritoneal dialysis was resumed immediately. The procedure resulted in long-term resolution of the infection in 20 of the 27 patients (74%). In 7 patients (26%), the catheter had to be removed eventually, either because of ESI recurrence (5 patients) or TI (2 patients), which in 2 cases was subsequently complicated by PD peritonitis, and the patients were switched to hemodialysis. Conclusion The technique described herein is a safe, straightforward, and effective method for the treatment of chronic ESI while the patient remains on PD and avoids switching to hemodialysis.

show abstract

A salvage technique for continuous ambulatory peritoneal dialysis catheters with exit-site infections

Cited by 22 publications

References 5 publications

ISPD Catheter-Related Infection Recommendations: 2017 Update

ISPD Catheter-Related Infection Recommendations: 2017 Update

Second surgical procedures for continuous ambulatory peritoneal dialysis patients: An analysis of 148 cases

Exit-Site Relocation: A Novel, Straightforward Technique for Exit-Site Infections

Contact Info

Product

Resources

About