Catheter Break-in for Continuous Ambulatory Peritoneal Dialysisuniversity of Missouri Experience

The present report describes more than nine years of experience with simultaneous removal and replacement of the chronic peritoneal dialysis (PD) catheter in treating refractory mechanical and infectious complications. Simultaneous catheter replacement and removal not only succeeded in 22 of 23 cases with non-infectious mechanical complications, allowing uninterrupted PD in all but three, but also succeeded in 30 (83%) of 36 additional cases with persisting or recurring infection. Simultaneous procedures failed in six (17%) of 36 infectious cases, due to persistent infection in two cases and to procedure complications in four cases. The clinical characteristics of the 30 successful infectious cases were compared to the characteristics of both the six failures, as well as 29 additional infectious cases in which the peritoneal catheter was removed but was not replaced because of a variety of serious complications (such as pancreatitis, abscess, sepsis, or fluid overload). At the time of simultaneous catheter replacement in successful cases, temporary control of active peritoneal inflammation was achieved more frequently (80% vs. 31%, P less than 0.001) with a shorter interval of antibiotic coverage (6.4 +/- 0.9 vs. 14.7 +/- 1.3 days, P less than 0.001). In addition, the successful cases were characterized by significantly more Staphylococcal infections (70% vs. 26%, P less than 0.001) and significantly fewer Pseudomonal or fungal infections (6% vs. 59%, P less than 0.001), although successful cases included some non-Pseudomonal, non-enteric gram negative infections (23%).(ABSTRACT TRUNCATED AT 250 WORDS)

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A New Approach for Catheter Placement and Care in CAPD

Henao

Mejia

Arbelaez

et al. 1985

Perit Dial Int

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Between April 1981 and December 1984, 54 double-cuff straight Tenckhoff catheters were inserted in 50 patients. This paper describes our experience with a new approach for catheter placement and care. It is based on a) ambulatory insertion by nephrologists; b) no flushing, heparinization or cycling; c) “break-in” delayed for two weeks and performed with regular two-liter bags; dialysis and d) ambulatory training carried out over 7–10 days. The actuarial survival rates of the catheters were 98% at 12 months and 80% at 24 and 36 months. Catheter failure was seen in six patients, three were due to peritonitis, two to tunnel infection and one to outflow obstruction caused by peritoneal adhesions. We conclude that this approach is feasible, safe, cheap and affordable and probably will produce less complications than other methods. Our nephrology section started a CAPD program in early 1981 but limited financial resources led us to devise a simplified and affordable protocol for catheter placement and care and for patient training and follow-up. Thus, we provide ambulatory catheter placement followed by two weeks without any type of peritoneal dialysis or catheter flushing. After this period, patients are trained as outpatients for seven to 10 days. This paper reports our experience with this approach.

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Catheter Break-in for Continuous Ambulatory Peritoneal Dialysisuniversity of Missouri Experience

Cited by 4 publications

References 3 publications

Peritoneal Catheter Placement and Management

Peritoneal Catheter Placement and Management

Simultaneous catheter replacement and removal in refractory peritoneal dialysis infections

A New Approach for Catheter Placement and Care in CAPD

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