Delayed complications following Tenckhoff catheter removal

Abstract

There is a significant risk of local sepsis with retained cuffs resulting from removal by traction and our data suggests that these catheters should be removed by dissection and excision of both cuffs.

Creating and Maintaining Optimal Peritoneal Dialysis Access in the Adult Patient: 2019 Update

“…Therefore, when the procedure is being performed for chronic exit-site infection with superficial cuff involvement, it is advisable to open up the exit site sufficiently to allow removal of the superficial cuff during the pullout (188). In cases of tunnel abscess necessitating drainage and debridement or catheter infection-related peritonitis where the deep cuff is involved with the transmural propagation of the infection, surgical removal of the catheter and cuffs is preferred (189).…”

Minimally invasive ‘pull technique’ for peritoneal dialysis catheter removal

“…Although it is recommended by an ISPD guideline/recommendation (2019 update), 7 some physicians are still unwilling to accept it for fear of complications, such as retained cuff infections and/or catheter breakage. Elkabir et al 1 reported a high infection rate (24.2%, 15 of 62 patients) for the retained cuffs, and Atkinson and Rubin 6 reported 29% (4 of 14) of the infected complications were related to the retained cuffs. Their findings may explain the unpopularity of the pull technique.…”

“…The standard technique for removing a peritoneal dialysis (PD) catheter is to surgically dissect the attached Dacron cuff and the silicone tube from the tissues to which it has become attached, 1,2 which requires one or two incisions. Since 1990, the ‘pull technique’ has been intermittently and sparsely reported on.…”

Three cases of retained cuff related infection after manual pull removal of peritoneal dialysis catheter

“…For example, none of the 17 patients reported by Hakim et al [1] exhibited infection, whereas only one patient exhibited retained cuff-related infection among the 31 patients reported by Quiroga et al [2] and 46 patients reported by Grieff et al [3]. However, Elkabir et al [4] reported that the 'pull technique' was used in 62 PD patients, of whom 15 (24.2%) developed retained cuffrelated infection. From the beginning of 2018 to the end of March 2020, a total of 30 PD catheters were removed by the 'pull technique' and 3 cases of retained cuff-related infections occurred, with an incidence rate of 10% at our center.…”