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

Abstract

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.

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

“…As far as catheter-related peritonitis is concerned, in our unit the extensive use of mini-invasive surgical technique in refractory tunnel infections could have prevented the occurrence of secondary peritonitis in some cases 19,20 ; while the employ of simultaneous removal and replacement of peritoneal catheter in peritonitis arising in conjunction with the exit-site or tunnel infections could have decrease the associated HD transfer rate 21 .…”

Ultrasonographic Findings of Catheter‐Related Bloodstream Infection in Pediatric Patients

“…Hyperechogenicity in soft tissue lesions indicates the presence of inflammation. 24,35,38,39 Hyperechogenicity on sonography in patients with CRBSI indicates that the inflammation in the vein has extended to the soft tissue surrounding the vein. Therefore, sonographers should carefully evaluate not only the vascular lumen, but also the tissues surrounding the vein.…”

“…To describe the sonographic findings of CRBSI, the following imaging findings, which have been reported as complications associated with catheters, catheter-related thrombophlebitis, and inflammatory changes, 12,24,[28][29][30][33][34][35][36] 1).…”

Minimally Invasive Peritoneal Dialysis Catheter Insertion with Intraoperative Ultrasound-Doppler Measurement of Rectus Muscle Width and Inferior Epigastric Artery Localization

“…In those patients, the curvilinear (abdominal) probe can be used to visualize the PDC entry into the rectus sheath. A vascular preset is preferred to prevent noise from superficial structures and movement with respiration [8,9]. Contrast enhanced ultrasound (CEUS) is an upgrade to standard US, which is very helpful in evaluating PDC malfunction, peritoneal-pleural communication, leakage, and herniation, and in particular, it facilitates dynamic functional imaging of the catheter and its complications.…”

“…US is also useful for evaluating other complications, especially PD-related infectious complications. Despite great efforts in preventing PDrelated infectious complications, approximately one third of PD failures are caused by them [9]. Hence, prompt exit site or tunnel infection diagnosis would allow fast and the most appropriate treatment, thereby decreasing the potential complications and reducing the PD failure rate [9].…”