Surgical Management of Refractory Exit-Site/Tunnel Infection of Tenckhoff Catheter: Technical Innovations of Partial Replantation

Abstract

Objective Catheter-related infection has been the major cause of catheter removal for peritoneal dialysis (PD) patients. A salvage technique — partial replantation of the infected catheter — was developed in our hospital to rescue catheters with refractory exit-site or tunnel infection. Patients We performed 26 partial replantations of Tenckhoff catheters for 23 patients with refractory exitsite or tunnel infection and 2 patients with near-cuff perforation of the catheter. Their problems were all resolved successfully without interruption of PD. Interventions We removed the infected portion of the catheter and preserved the still-functioning internal conduit, connecting it to a divided new catheter. All of the patients resumed PD immediately after the advancement of the new catheter through a new subcutaneous tunnel and exit site on the opposite side. Results No technical complications such as disconnection of the catheter or leakage of dialysate were noted. Repeated partial replantation of the catheter was done for 1 patient with a new refractory exit-site infection. Tunnel infection was not an absolute contraindication for this procedure. About one third (34.6%) of our patients had preoperative tunnel infection. Conclusion Partial replantation of a Tenckhoff catheter is a simple and effective procedure for patients with refractory exit-site/tunnel infection and patients with near-cuff perforation of the catheter. Repeated partial replantation is also feasible for repeat exit-site infections.

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

“…However, efforts have been made by some clinicians to retain the catheter (Table 4). 4,10,[18][19][20][21][22][23][24][25][26][27][28] Several treatment modes could be applied prior to catheter removal due to refractory ESI and TI. 13,14 First, deroofing of the tunnel or exteriorization of the external cuff might be performed.…”

“…[20][21][22] Some authors have proposed a partial replantation of the infected catheter: the subcutaneous portion of the catheter is removed and the external portion of a new catheter is connected with an internal stent, sealed with a medical adhesive silicone glue to the remaining portion of the implanted catheter. 20,[24][25][26] Peritoneal dialysis can resume immediately after a partial replantation. 20 However, the disadvantage of this technique lies in the manipulation and modification of the original catheter structure.…”

A new connecting technique in partial replantation of a ruptured peritoneal dialysis catheter

“…In previous reports of partial replantation, a medical adhesive glue or a specific endoluminal connector was used to connect the remaining part of the old catheter to the extraperitoneal segment of a new catheter. In early reports [1] , [2] , a stenting tube (a segment of siliconized tube taken from an infusion extension set) was inserted into the inner lumen of both catheters, and an adhesive silicone type A glue was used to seal the interfaces between the catheters and the stenting tube. The authors indicated that the length of the stenting tube is very important, because a tube that is too short increases the risk of leakage or disconnection, and a tube that is too long protrudes and causes the patient discomfort.…”

“…However, this requires an interruption in PD and subsequent hemodialysis (HD) catheter insertion for temporary transfer to HD. Therefore, partial replantation of the catheter instead of removal of the whole catheter has been suggested [1] , [2] , [3] . In previous reports of partial replantation, medical adhesive glue or a specific endoluminal connector was used to connect the remaining part of the old catheter to the extraperitoneal segment of a new catheter.…”

Reducing intra‐abdominal pressure in peritoneal dialysis patients to avoid transient hemodialysis

“…Another potential approach to refractory exit‐site infections includes partial replantation of the external portion of the PD catheter (new subcutaneous tunnel and exit site) with preservation of the internal component of the catheter. This was first used successfully in 23 patients in Taiwan and allows for un‐interrupted PD without concerns about dialysate leaks around the deep cuff. In a subsequent study of 74 PD patients with refractory exit‐site or tunnel infections, partial catheter replacement with a new tunnel and exit site creation was successful in 100% of the patients compared to 57% of the patients on prolonged antibiotic therapy.…”