The impact of the superficial cuff position on the exit site and tunnel infections in CAPD patients

Nardelli, Luca; Scalamogna, Antonio

doi:10.1007/s40620-020-00788-z

Cited by 9 publications

(6 citation statements)

References 48 publications

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Section: Methodsmentioning

confidence: 99%

“…After obtaining informed consent for catheter insertion, double-cuffed Tenckhoff catheter was placed by an interventional nephrologist according to semi-surgical or surgical procedure described thoroughly elsewhere. [22][23][24] Incremental CAPD was defined as the start of PD with less than four exchanges per day, 7 days a week and a peritoneal weekly Kt/V < 1.7 per week, but a total weekly Kt/V ! 1.7 per week.…”

Section: Capd Dose Prescriptionmentioning

confidence: 99%

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Relationship between number of daily exchanges at CAPD start with clinical outcomes

Nardelli,

Scalamogna,

Cicero

et al. 2023

Perit Dial Int

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Background: Peritoneal dialysis (PD) continues to be demanding for patients affected by kidney failure. In kidney failure patients with residual kidney function, the employment of incremental PD, a less onerous dialytic prescription, could translate into a decrease burden on both health systems and patients. Methods: Between 1st January 2009 and 31st December 2021, 182 patients who started continuous ambulatory peritoneal dialysis (CAPD) at our institution were included in the study. The CAPD population was divided into three groups according to the initial number of daily CAPD exchanges prescribed: one or two (50 patients, CAPD-1/2 group), three (97 patients, CAPD-3 group) and four (35 patients, CAPD-4 group), respectively. Results: Multivariate analysis showed a difference in term of peritonitis free survival in CAPD-1/2 in comparison to CAPD-3 (hazard ratio (HR): 2.20, p = 0.014) and CAPD-4 (HR: 2.98, p < 0.01). A tendency towards a lower hospitalisation rate (CAPD-3 and CAPD-4 vs. CAPD-1/2, p = 0.11 and 0.13, respectively) and decreased mortality (CAPD-3 and CAPD-4 vs. CAPD-1/2, p = 0.13 and 0.22, respectively) in patients who started PD with less than three daily exchanges was detected. No discrepancy of the difference of the mean values between baseline and 24 months residual kidney function was observed among the three groups ( p = 0.33). Conclusions: One- or two-exchange CAPD start was associated with a lower risk of peritonitis in comparison to three- or four-exchange start. Furthermore, an initial PD prescription with less than three exchanges may be associated with an advantage in term of hospitalisation rate and patient survival.

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Section: Methodsmentioning

confidence: 99%

Section: Capd Dose Prescriptionmentioning

confidence: 99%

Relationship between number of daily exchanges at CAPD start with clinical outcomes

Nardelli,

Scalamogna,

Cicero

et al. 2023

Perit Dial Int

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“…In every patient a straight double-cuffed Tenckhoff catheter was placed with a modi ed double purse string technique around the inner-cuff either in semi-surgical or surgical procedure, as described elsewhere 9,10 . The creation of the subcutaneous part was achieved by using a piercing tunneller in a direction able to minimize shear forces with the super cial cuff located at least 4 cm from the exit of the skin 11 . As far as routinely exit-site care is concerned, patients were instructed to apply hydrogen peroxide followed by 5% sodium hypochlorite solution to the skin surface three to four times per week.…”

Section: Clinical Managementmentioning

confidence: 99%

Peritoneal Dialysis Related Peritonitis: Insights From a Long-Term Analysis of an Italian Center

Nardelli,

Scalamogna,

Ponzano

et al. 2023

Preprint

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Background Peritonitis is a common and severe complication of peritoneal dialysis (PD). For comparative analysis standardized definitions as well as measurements and outcomes are crucial. However, most PD-related peritonitis studies have been using heterogenous definitions and variable methods to measure outcomes. The ISPD 2022 guidelines have revised and clarified numerous definitions and proposed new peritonitis categories and outcomes. Methods Between 1st January 2009 and 31st May 2023, 267 patients who started PD at our institution were included in the study. All PD-related peritonitis episodes that occurred in our unit during the study period were collected. The new definitions and outcomes of ISPD 2022 recommendations were employed. Results The overall peritonitis rate was 0.25 episode/patient year. Patient cumulative probability of remaining peritonitis-free at one year was 84.2%. The medical cure and refractory peritonitis rates were equal to 70.3 and 22.4%, respectively. Culture-negative peritonitis accounted for 25.6% of all specimens. The rates of peritonitis associated death, HD transfer, catheter removal and hospitalization were 6.8%, 18.3%, 18.7% and 64.4%, respectively. Relapsing, repeat, recurrent and enteric peritonitis accounted for 7.8%, 6.8%, 4.1% and 2.7% of all episodes, respectively. Catheter insertion, catheter related and pre-PD peritonitis were 4.2, 2.1 and 0.5%. Conclusions The implementation of PD-related peritonitis reports using standardized definitions and outcome measurements is of paramount importance to enhance clinical practice and to allow comparative studies.

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“…For this purpose, ultrasound (US) examination represents a non-invasive, relatively simple, repeatable, well tolerated and readily available method for the evaluation of the exit-site and tunnel of the peritoneal catheter [23]. Cantaluppi et al in 1985 were the first to suggest the use of US to diagnose TIs [24].…”

Section: Introductionmentioning

confidence: 99%

“…During this progression the microorganisms can colonize the Dacron of the superficial cuff and form a biofilm in this area that facilitates their proliferation [ 17 , 18 ]. The creation of this layer around the superficial cuff makes these infections unresponsive to medical therapy [ 19 , 20 ]. Furthermore, the bacterial colonization of the exit-site and superficial cuff would increase the probability of contamination of the patient's hands and, consequently, the passage of microorganisms into the catheter lumen during the exchange maneuvers (intraluminal route).…”

Section: Introductionmentioning

confidence: 99%

Utility of ultrasonographic examination in catheter-related infections in peritoneal dialysis: a clinical approach

2023

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Peritoneal dialysis- (PD) related infections continue to be a major cause of morbidity and mortality in patients on renal replacement therapy via PD. However, despite the great efforts in the prevention of PD-related infectious episodes, approximately one third of technical failures are still caused by peritonitis. Recent studies support the theory that ascribes to exit-site and tunnel infections a direct role in causing peritonitis. Hence, prompt exit site infection/tunnel infection diagnosis would allow the timely start of the most appropriate treatment, thereby decreasing the potential complications and enhancing technique survival. Ultrasound examination is a simple, rapid, non-invasive and widely available procedure for tunnel evaluation in PD catheter-related infections. In case of an exit site infection, ultrasound examination has greater sensitivity in diagnosing simultaneous tunnel infection compared to the physical exam alone. This allows distinguishing the exit site infection, which will likely respond to antibiotic therapy, from infections that are likely to be refractory to medical therapy. In case of a tunnel infection, the ultrasound allows localizing the catheter portion involved in the infectious process, thus providing significant prognostic information. In addition, ultrasound performed after two weeks of antibiotic administration allows monitoring patient response to therapy. However, there is no evidence of the usefulness of ultrasound examination as a screening tool for the early diagnosis of tunnel infections in asymptomatic PD patients.

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The impact of the superficial cuff position on the exit site and tunnel infections in CAPD patients

Cited by 9 publications

References 48 publications

Relationship between number of daily exchanges at CAPD start with clinical outcomes

Relationship between number of daily exchanges at CAPD start with clinical outcomes

Peritoneal Dialysis Related Peritonitis: Insights From a Long-Term Analysis of an Italian Center

Utility of ultrasonographic examination in catheter-related infections in peritoneal dialysis: a clinical approach

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