Cuff-shaving procedure. A rescue treatment for exit-site infection unresponsive to medical therapy

Abstract

We performed 41 cuff-shaving procedures in 38 patients on continuous ambulatory peritoneal dialysis (CAPD) with exit-site infection unresponsive to medical treatment. Cuff shaving was performed on three patients with two catheters each. This procedure was effective in eliminating 50% of S. aureus exit-site infection and all S. epidermidis exit-site infection, but was ineffective in Gram-negative exit-site infection. After cuff-shaving procedure, 20 catheters (49%) were removed; 11 for persistent tunnel infection and nine because of development of secondary peritonitis. The probability of catheter survival at 1 year was 50% and remained stable thereafter. Cuff-shaving procedure may be a valuable mode of therapy for treating patients with S. aureus and/or S. epidermidis exit-site infection unresponsive to medical treatment.

Merit of the cuff-shaving procedure in children with tunnel infection

“…The spectrum of causative agents was similar to that reported in previous studies [9,12,14,15,16,17]. Even in studies showing the effectiveness of the cuff-shaving procedure, the therapeutic outcome was reported to be poor in infections due to Gram-negative rods [9,10], but in our study there was no significant difference among all the detected causative agents with regard to the TI time after cuff-shaving (Figs. 3 and 4).…”

“…Cuff-shaving has been studied only in adults and has been effective in some studies [6,9,10,11,12] but not in others [13]. However, the cuff-shaving procedure has not been studied in children.…”

Mechanical Complications of Peritoneal Dialysis

“…However, in the largest series to date, Scalamogna reported a 50% 1 year survival after cuff shaving for staph aureus and staph epidermidis. Unfortunately, shortly after the procedure, 20 catheters (49%) were removed for either persistent tunnel infection or development of peritonitis [88]. In addition, Tan reported a 77% catheter survival after an average follow-up of 8.3 months using cuff shaving with a common razor [89].…”

“…Since maintaining a functioning catheter is of the utmost importance in renal failure patients, it is generally preferable to salvage an existing functioning catheter as opposed to replacing it and risking fluid leak, malfunction, infection and need for switch to hemodialysis. Salvage techniques such as external cuff shaving [84][85][86][87][88][89] deroofing of the exit site [90] and replacing the external segment of the catheter by splicing and repairing the catheter [91] have been reported.…”

Continuous Ambulatory Peritoneal Dialysis in Patients after Infra-Abdominal Prosthetic Vascular Graft Surgery

“…These 5 episodes of peritonitis responded to a stan dard protocol of treatment with intraperitoneal tobramy- During the follow-up, 3 patients experienced 6 epi sodes of exit-site infections (1/34.6 patient-months); 3 episodes were resolved after medical therapy. One epi sode of exit-site and tunnel infection, unresponsive to medical treatment, required the removal of the peritoneal catheter (patient 5): the other 2 episodes of exit-site infec tion (patients 4 and 5) were resolved after surgical shaving of the infected outer Dacron cuff of the catheter according to the technique reported by Scalamogna et al [12] (ta ble 2). In the control group, during the follow-up, 14 epi sodes of exit-site infection were diagnosed in 7 patients (1/34 patient-months); 10 of them resolved after medical therapy, 2 healed after cuff-shaving and the remaining 2 required the removal of the catheter after unsuccessful cuff-shaving.…”