Removal and Replacement of Tenckhoff Catheter at a Single Operation: Successful Treatment of Resistant Peritonitis in Continuous Ambulatory Peritoneal Dialysis

Paterson, Andrew D.; Mc, Bishop; Ag, Morgan; Rp, Burden

doi:10.1016/s0140-6736(86)92676-0

Cited by 35 publications

(12 citation statements)

References 11 publications

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“…Although no standard dialysis prescription exists for immediate resumption of PD, a low volume, supine, intermittent PD protocol to minimize the risk of leak was used in most studies (5,7,10,12,13). The use of a cycler in this clinical setting is particularly convenient.…”

Section: Discussionmentioning

confidence: 99%

“…The International Society for Peritoneal Dialysis (ISPD) guidelines for PD-related infections do not address the optimal duration of antibiotic coverage following SCR (9). Previous studies have described postoperative antibiotic coverage for 3 – 5 days (4,10), 1 week (5,11,12), 2 weeks or more (13), or omitted mentioning it altogether (6,7). Using the Centers for Disease Control and Prevention's classification of surgical wounds, we categorized SCR for peritonitis and tunnel infections as Class IV cases consisting of an existing infection with organisms present before the procedure (14).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, it has been used for mechanical complications, e.g., flow failure, peri-catheter leaks, and irreparable tubing damage (3). Often, PD was continued after the catheter exchange procedure without temporary HD, but the practices were incompletely described (4-7). On occasion, management included temporary HD with a central venous catheter while waiting for surgical wounds to heal sufficiently to prevent dialysate leakage.…”

mentioning

confidence: 99%

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Simultaneous Catheter Replacement for Infectious and Mechanical Complications without Interruption of Peritoneal Dialysis

Crabtree

Siddiqi

2015

Perit Dial Int

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Simultaneous Catheter Replacement for Infectious and Mechanical Complications without Interruption of Peritoneal Dialysis

Crabtree

Siddiqi

2015

Perit Dial Int

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“…The presence of microbiological by‐products (biofilm) on mostperitoneal catheters wouldsuggest that removal of the peritoneal catheter may be essential to cureunresponsive peritonitis. Reimplantation of a new peritoneal catheter may bedone when the infection comesunder control, although some have reported success of removing one catheter andreplacing a new catheter at the same time (6). However, the general recommendation at this time is to delayimplanting a new catheter for two to three weeks after catheter removal, inpatients who have a pyogenic organism.…”

Section: Discussionmentioning

confidence: 99%

A Dialysis Case Presentation and Discussion: Unrelenting Peritonitis in a CAPD Patient

Moncrief

1997

Seminars in Dialysis

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Case PresentationS.K., a 50 year old white female who lived all of her life in central Texas, presented in mid-1996 with cloudy dialysate after having undergone successful continuous ambulatory peritoneal dialysis (CAPD) for 18 months. The white blood cell (WBC) count in the dialysate was 250/mm 3 with 80 percent granulocytes and 20 percent monocytes. Initial therapy was vancomycin 2 grams in one overnight exchange and gentamicin 15 mg in each exchange pending culture reports. Within 48 hours, the WBC count in the dialysate (on a four hour dwell) had fallen to 150/mm 3 ; all cultures were sterile. The patient was previously known to have a chronic exit site infection. An ultrasound of her catheter tunnel was remarkable for some fluid accumulation along the catheter track consistent with a tunnel infection. Multiple cultures were obtained with only one set yielding staphylococcus aureus. The initially low WBC, however, was felt to mitigate against true staphylococcus aureus peritonitis. The issue of a possible vancomycin induced WBC elevation in the dialysate was also considered and antibiotics were subsequently discontinued. The patient was carefully observed over a five to six day period, in which her dialysate remained only mildly cloudy and the WBC (on four hour dwells) varied between 150 and 525 WBC's/mm 3 with 95% polys. Repeated reculturing of the dialysate failed to grow any pyogenic organism.Additional questioning of the patient about her past medical history revealed a history of a chronic low grade fever beginning eight months prior to the onset of peritonitis. She experienced night sweats, anorexia, decreased exercise tolerance and weight loss. She also developed progressive anemia and hypoalbuminemia. In spite of the ingestion of dietary protein supplements, her serum albumin remained between 2.0 and 2.5 grams percent. Her anemia was characterized as a macrocytic anemia but vitamin B12 and folic acid serum concentrations on several examinations were normal. In addition, her reticulocyte count was between 1.2 and 1.6 and could not explain the macrocy-tosis. Her history also included heavy alcohol ingestion, and she smoked 2-3 packages of cigarettes per day for an excess of 15 years. The question of alcoholic hepatitis, cirrhosis, underdialysis and malabsorption were all considered as possible underlying causes of the patient's ''failure to thrive.'' Ultimately, fluconazole therapy was initiated based on the clinical suspicion of yeast peritonitis. Three weeks after the initial presentation of cloudy dialysate, during which time the dialysate was still slightly hazy and the WBC count in the dialysate remained at 200/mm 3 , one of the initial cultures grew Histoplasma capsulatum. The catheter was removed within 24 hours. Subsequently, itraconazole therapy was stated and the patient was converted to intermittent hemodialysis. Within 48 hours after treatment with itraconazole, the patient had a defervescence, an increase in appetite, a resolution of her anorexia and an increase in physical endurance. Durin...

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“…Some authors rec ommend replacement after 3 weeks in a site distant from the original site, only if no active infection is present [13]. Other au thors have had success in replacing the cath eter in a shorter interval, but no well-controlled study exists at the present time for a definitive answer [33], For exit-site infections, again, little data are available. The type of antibiotic, dura tion of therapy and length of time to re sponse are not well defined.…”

Section: Miscellaneousmentioning

confidence: 99%

Antimicrobial Therapy for CAPD-Associated Peritonitis

Winton

Everett²

1989

Blood Purif

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Infectious peritonitis continues to be the leading cause of morbidity in patients on continuous ambulatory peritoneal dialysis (CAPD). Optimum management of CAPD-associated peritonitis requires a concerted effort toward the establishment of the specific agent causing the episode. We have reviewed the current literature relating to the diagnosis and institution of antimicrobial therapy. Controlled comparative trials are needed to determine the efficacy of potentially less toxic therapeutic regimens for peritonitis, for definition of and treatment of exit-site infections, and timing of catheter replacement.

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Removal and Replacement of Tenckhoff Catheter at a Single Operation: Successful Treatment of Resistant Peritonitis in Continuous Ambulatory Peritoneal Dialysis

Cited by 35 publications

References 11 publications

Simultaneous Catheter Replacement for Infectious and Mechanical Complications without Interruption of Peritoneal Dialysis

Simultaneous Catheter Replacement for Infectious and Mechanical Complications without Interruption of Peritoneal Dialysis

A Dialysis Case Presentation and Discussion: Unrelenting Peritonitis in a CAPD Patient

Antimicrobial Therapy for CAPD-Associated Peritonitis

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