Nephrology Dialysis Transplantation, Vol 13, Issue 3 700-703, Copyright © 1998 by Oxford University Press
N Posthuma, P Borgstein, Q Eijsbouts and P ter Wee
Catheter-related infections result in high patient morbidity, the need for
temporary haemodialysis, and high costs. These infections are the main
cause of limited technique survival in peritoneal dialysis. We introduced a
protocol for the simultaneous peritoneoscopic insertion and removal of
peritoneal catheters in patients with catheter-related infections.
Peritoneal dialysis was continued the day after surgery using low-volume
dwells and a dry abdomen during the daytime. The dialysate leukocyte count
had to be below 100/mm3 before exchanging catheters,
which was performed under antibiotic therapy based on culture sensitivity.
The old catheter was removed after the new catheter had been inserted in
the opposite abdominal region. CAPD patients were switched to APD for 1
week, which made prolonged hospitalization necessary. Simultaneous catheter
insertion and removal was performed 25 times in 22 patients on CCPD and 15
times in 14 patients on CAPD. In CCPD patients, peritoneal dialysis was
restarted after 1.0+0.1 days in 24 cases. One patient had sufficient
residual renal function and discontinued CCPD until day 10. In 10 CAPD
patients (11 procedures) APD was started 1.3±0.2 days after the
procedure with CPD beginning 7.1±0.6 days thereafter. Three CAPD
patients preferred haemodialysis and restarted CAPD 10.0±2.1
days after surgery. One patient continued CAPD the day after surgery. In
addition to minor complications (e.g. position-dependent outflow problems),
dialysate leakage occurred in two patients. Two patients developed
peritonitis within the first 30 days after surgery, one of which was
procedure related. One patient had severe lower gastrointestinal bleeding 2
weeks after the procedure, which was not related to the catheter
replacement. Ultimately, in 38 of 40 procedures the patients could
successfully continue peritoneal dialysis. We conclude that simultaneous
insertion and removal of a peritoneal dialysis catheter without
interruption of peritoneal dialysis is a safe procedure in patients with
catheter-related infections. Key words: CAPD;
catheter-related infections; CCPD; dialysate leakage; dialysis;
peritoneoscopy; Pseudomonas
ORIGINAL ARTICLES
Simultaneous peritoneal dialysis catheter insertion and removal in catheter-related infections without interruption of peritoneal dialysis
Departments of Nephrology and Surgery, ICaR-VU, Academic Hospital Vrije Universiteit, Amsterdam, the Netherlands; Corresponding author at: Academisch Ziekenhuis Vrije Universiteit, Department of Nephrology, Postbus 7057, 1007 MB Amsterdam, The Netherlands
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