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

Abstract

Catheter replacement and cuff-shaving are per-formed as a surgical treatment against tunnel infection(TI) in patients on chronic peritoneal dialysis. The efficacy of catheter replacement is well established, but that of cuff-shaving is not. For the purpose of evaluating the efficacy of cuff-shaving, we compared the time interval between each procedure and subsequent TI. In order to perform this comparison, we reviewed data from 32 cuff-shaving procedures and 29 catheter replacement procedures at Tokyo Metropolitan Kiyose Children's Hospital in the period from 1 March 1991 to 1 May 2001, retrospectively. There was no significant difference in the time interval between each procedure and subsequent TI(P=0.284). The incidence of recurrence was no more than 12.5% for the cuff-shaving procedures. The incidence of peritonitis due to post-surgery TI with the cuff-shaving procedures was 9.3% and 6.8% with the replacement procedure (P=0.725). There was no significant variation in time interval to post-cuff-shaving TI according to the reason for the cuff-shaving procedure. In conclusion,cuff-shaving may be worth considering for TI in adequately selected patients.

Catheter revision for the treatment of intractable exit site infection/tunnel infection in peritoneal dialysis patients: A single centre experience

“…Compared to catheter replacement, cuff shaving has the following advantages: less invasiveness as a surgical procedure, shortening of hospital stay and reduction in the frequency of catheter replacement 4 . Catheter salvage rates by cuff shaving were reported to be 48–100% 20 .…”

“…Among the complications, catheter‐related infections such as exit site infection (ESI) and tunnel infection (TI) are important causes of technical failure and interruption of PD 2 . Although most ESI respond well to antibiotic treatment, ESI are sometimes refractory to medical therapy and these infections require surgical procedures 3,4 . Various attempts to prevent ESI have included novel catheter designs, diverse methods of catheter insertion, appropriate education for nursing personnel and the use of prophylactic antibiotics including topical application of mupirocin 5–9 …”

Mechanical Complications of Peritoneal Dialysis

“…The incidence of recurrence of infection was 12.5% after the cuff shaving procedure with a 9.4% incidence of peritonitis. They concluded that compared to replacing the catheter, cuff shaving was less expensive, shortened hospital stay, and reduced the frequency of catheter replacement [92]. Another pediatric study reviewed 13 patients who underwent cuff shaving and formation of a new subcutaneous tunnel with exit site in the opposite side of the abdomen.…”

Guidelines for laparoscopic peritoneal dialysis access surgery

“…Exit site infections in the pediatric population are less likely to respond to antibiotics alone and surgical salvage may be needed. ''Cuff shaving'' by unroofing the subcutaneous cuff, shaving it off, and rerouting the catheter to an alternate exit site has been reported successful in 87.5 % of children in one study from Japan [180]. This technique was which the entire subcutaneous tubing was replaced from just above the internal cuff with no interruption in dialysis [182].…”