Extrusion of both Superficial and Deep Cuffs of a Functional Double-Cuff Peritoneal Dialysis Catheter after Significant Weight Loss

Extrusion of the superficial cuff of a peritoneal dialysis (PD) catheter is an uncommon complication that may be associated with infection or malfunction. However, extrusion of both the superficial and deep cuffs of a double-cuff catheter is rare and uniformly associated with failure and peritonitis. We report a case of a presternal-type PD double-cuff catheter with extrusion of both cuffs through an abdominal exit site after 6 years of use that has remained functional, which has not been previously reported. In this case, the patient had achieved a 60-kg weight loss resulting in retraction of the subcutaneous tissue around both cuffs, while the catheter was held in place by the titanium connector between the presternal extension tubing and the inner, coiled catheter. In such special circumstances, extrusion of both cuffs may not necessitate urgent catheter removal. A review of the literature revealed previous cases of superficial cuff extrusions with catheters remaining functional but not with deep cuff extrusion.

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Selective Infracolic Omentecomy and Fixation Reduces Complications after Laparoscopic Assisted Peritoneal Dialysis Catheter Placement

10.33169/surg.gsoaoj-i-103 ◽

2018 ◽

Vol I (1) ◽

pp. 06-11

Author(s):

Andries Ryckx

Keyword(s):

Peritoneal Dialysis ◽

Catheter Placement ◽

P Value ◽

Peritoneal Dialysis Catheter ◽

Dialysis Catheter ◽

Exit Site ◽

Exit Site Infection ◽

Catheter Survival ◽

Catheter Obstruction ◽

Infracolic Omentectomy

Introduction Peritoneal dialysis (PD) as a treatment for patients with end-stage renal disease (ESRD) provides a competitive alternative to hemodialysis (HD). Long-term catheter survival remains challenging and techniques are not standardized. Advanced laparoscopic placement with fixation and omentectomy might increase catheter survival. The goal of our study was to evaluate if selective infracolic omentectomy and fixation reduced complications after CAPD catheter placement. Materials and Methods A prospective database of patients with CAPD catheter placement from March 2004 to March 2015 was analyzed. All procedures were performed laparoscopically assisted and under general anesthesia by a single surgeon. 78 patients were included, there were no exclusion criteria. Statistical analysis was performed with SPSS. Fisher exact test and log-rank test with calculation of P-value was executed. P-value of <0.05 was considered significant. Results Of the 78 patients who underwent catheter placement, 53 (68%) were males and 25 (32%) were females. The mean age was 54 (ranged from 13 to 88 years). Selective infracolic omentectomy was performed in 32 patients if the momentum reached beyond the promontory. Non-resorbable sutures to fix the catheter were applied in 33 patients. The average duration of peritoneal dialysis was 21 months (range from ten days to 84 months). Omentectomy significantly reduced the incidence of catheter obstruction (3 vs. 11%, P=0.028) but not of catheter dislocation (19 vs. 30%, P=0.101). Omentectomy did not significantly increase the incidence of peritonitis (22 vs. 31%,P=0.133) or exit-site infection (16vs 17%, P=0.238). Catheter fixation with non-resorbable sutures reduced catheter dislocation (21 vs. 23%, P=0.226) and catheter obstruction( 12 vs.17%,P=0.223) with a significant reduction of peritonitis (15 vs. 29%, P=0.044) and no effect on exit-site infection (15 vs. 17%,P=0.251). Conclusion Laparoscopic PD catheter placement with selective omentectomy and fixation of the catheter to the abdominal wall is safe and feasible and leads to fewer complications. Key words: peritoneal, dialysis, catheter, complications, laparoscopy, omentectomy.

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Peritoneal dialysis catheter insertion surgery and management

The Journal of Vascular Access ◽

10.1177/1129729818762989 ◽

2018 ◽

Vol 20 (1_suppl) ◽

pp. 97-99

Author(s):

Kazunari Yoshida ◽

Daisuke Ishii

Keyword(s):

Peritoneal Dialysis ◽

Invasive Surgery ◽

Catheter Insertion ◽

Peritoneal Dialysis Catheter ◽

Dialysis Catheter ◽

Less Invasive Surgery ◽

Exit Site ◽

Less Invasive ◽

Access Surgery ◽

Dialysis Discontinuation

Peritoneal access surgery is the first step to achieve successful peritoneal dialysis. It is important to perform easy, safe, and less invasive surgery of peritoneal dialysis catheter insertion. Secure peritoneal dialysis catheter insertion will lead to less infection, that is, exit site, tunnel infection, and peritonitis, which sometimes result in peritoneal dialysis discontinuation. To avoid these undesirable results, we should perform good and proper peritoneal dialysis insertion surgery. In this article, we describe peritoneal dialysis catheter insertion surgery and its management.

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Small bowel herniation and gangrene from peritoneal dialysis catheter exit site

Pediatric Nephrology ◽

10.1007/s00467-002-1022-z ◽

2003 ◽

Vol 18 (3) ◽

pp. 301-302 ◽

Cited By ~ 4

Author(s):

Kenneth K. Y. Wong ◽

Lawrence C. L. Lan ◽

Steve C. L. Lin ◽

Paul K. H. Tam

Keyword(s):

Peritoneal Dialysis ◽

Small Bowel ◽

Peritoneal Dialysis Catheter ◽

Dialysis Catheter ◽

Exit Site ◽

Bowel Herniation

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Repair of Chronic Peritoneal Dialysis Catheter

Peritoneal Dialysis International ◽

10.1177/089686089801800412 ◽

1998 ◽

Vol 18 (4) ◽

pp. 419-423 ◽

Cited By ~ 8

Author(s):

Kumari Usha ◽

Leonor Ponferrada ◽

Barbara F. Prowant ◽

Zbylut J. Twardowski

Keyword(s):

Peritoneal Dialysis ◽

Prophylactic Antibiotic ◽

Patch Repair ◽

Peritoneal Dialysis Catheter ◽

Safe Procedure ◽

Dialysis Catheter ◽

Exit Site ◽

Accidental Injury ◽

Extension Tube ◽

Catheter Replacement

Background Damage to the peritoneal dialysis catheter may be due to wear from long-term use, exposure to antibacterial agents (strong oxidants), and accidental injury from sharp objects. Repair of such catheter, if not associated with subsequent complications, would extend catheter life and reduce costs and patient inconvenience related to catheter replacement. Objective and Design Retrospective analysis of seven peritoneal catheters repaired 11 times over a 15-year period by splicing the old catheter with an extension tube using the Peri-Patch Repair Kit (Quinton Instrument Co., Bothwell, WA, U.S.A.). Results The life of these seven catheters was extended by a mean of 26 months (range 1 -87 months), without increasing infection rates after splicing. The peritonitis rate after catheter splicing was 0.40 per year, not higher than the overall rate (0.76 per year) in our center during the same time period. Exit-site infections occurred in 6 patients after catheter splicing. Only one infection was related to trauma during the procedure and resulted in chronic exit infection; the catheter was eventually removed. In this patient, damage to the catheter was less than 1.5 cm from the exit site. Conclusions and Recommendations Splicing of the damaged peritoneal catheter, if properly done, is a safe procedure and can significantly prolong catheter life. We recommend that measures to prevent catheter damage, such as avoiding the use of scissors and other sharp objects, should be emphasized during the initial patient education and training. Alcohol and iodine should not be used on silicone rubber catheters. We suggest that the patient should report catheter damage immediately and come to the clinic within a few hours for catheter splicing (if possible) and prophylactic antibiotic to prevent peritonitis. Finally, we recommend that repair of the catheter should not be attempted if the breakage is less than 2 cm from the exit site, unless done as an emergency procedure if immediate catheter replacement cannot be performed.

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Peritoneal Dialysis Catheter Exit-Site Care: Results of an International Survey

Peritoneal Dialysis International ◽

10.1177/089686089301300214 ◽

1993 ◽

Vol 13 (2) ◽

pp. 149-154 ◽

Cited By ~ 42

Author(s):

Barbara F. Prowant ◽

Judith Y. Bernardini ◽

Betty Kelman ◽

Barbara F. Prowant ◽

Bradley A. Warady ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Peritoneal Dialysis Catheter ◽

Dialysis Catheter ◽

International Survey ◽

Exit Site

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11. Peritoneal dialysis catheter-related infection: exit site and tunnel

Nephrology ◽

10.1111/j.1440-1797.2004.00294.x ◽

2004 ◽

Vol 9 (S3) ◽

pp. S82-S85 ◽

Cited By ~ 1

Keyword(s):

Peritoneal Dialysis ◽

Peritoneal Dialysis Catheter ◽

Dialysis Catheter ◽

Exit Site ◽

Catheter Related Infection

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The Need for a “Swan Neck” Permanentl Y Bent, Arcuate Peritoneal Dialysis Catheter

Peritoneal Dialysis International ◽

10.1177/089686088500500404 ◽

1985 ◽

Vol 5 (4) ◽

pp. 219-223 ◽

Cited By ~ 82

Author(s):

Zbylut J. Twardowski ◽

Karl D. Nolph ◽

Ramesh Khanna ◽

Barbara F. Prowant ◽

Leonor P. Ryan ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Complication Rate ◽

Rectus Muscle ◽

Peritoneal Dialysis Catheter ◽

Dialysis Catheter ◽

Exit Site ◽

The Past ◽

Optimal Function ◽

Catheter Tip ◽

Subcutaneous Tunnel

In 1968 to ensure optimal function of a permanent catheter during periodic peritoneal dialysis, Tenckhoff recommended that a double-cuff catheter be inserted so that a slightly arcuate subcutaneous course would give the external and intraperitoneal segment a caudal direction. During the rapid growth of CAPD over the past five years, nephrologists generally have adapted the Tenckhoff's methods of catheter insertion but have encountered numerous complications. This paper describes a retrospective analysis of the complications associated with 83 peritoneal dialysis catheters functioned for 48,325 catheter days (132 catheter years) in 63 patients on continuous ambulatory peritoneal dialysis (CAPD) at our institution. Pericatheter leaks were seen only with midline insertions. Exit-site infections were significantly more resistant to treatment with singlecuff than with double-cuff catheters as assessed by the proportion of time that the exit-site is infected. If the subcutaneous tunnels were directed downward the infections were more responsive to treatment. Significantly more frequent catheter-tip migrations were observed with subcutaneous tunnel directed left and downward. Thus, our study supports Tenckhoff's observation that we can expect the lowest complication rate with double-cuff catheters with an arcuate tunnel, convex upwards. However, frequently this shape of tunnel is associated with external-cuff extrusions due to resilience of the straight catheter. To reconcile these conflicting requirements we recommend a new catheter permanently bent between the cuffs to eliminate one of the forces responsible for cuff extrusion. Such a catheter, named the swan-neck tunnel peritoneal dialysis catheter, should be inserted surgically through the belly of the rectus muscle.

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Continuous Ambulatory Peritoneal Dialysis Catheter Infections: Diagnosis and Management

Peritoneal Dialysis International ◽

10.1177/089686089401400310 ◽

1994 ◽

Vol 14 (3) ◽

pp. 248-254 ◽

Cited By ~ 33

Author(s):

Michael J. Flanigan ◽

Linda A. Hochstetler ◽

Donita Langholdt ◽

Victoria S. Lim

Keyword(s):

Peritoneal Dialysis ◽

Antibiotic Therapy ◽

Minimal Risk ◽

Peritoneal Dialysis Catheter ◽

Dialysis Catheter ◽

Exit Site ◽

Gram Negative ◽

Home Dialysis ◽

Serous Discharge ◽

Catheter Infections

Purpose To develop diagnostic and treatment strategies for peritoneal dialysis catheter exit-site and tunnel infections. Population All consenting peritoneal dialysis patients performing home dialysis through the University of Iowa Hospitals and Clinics Home Dialysis Training Center. This is a state-owned teaching hospital serving a rural population of approximately one million people in Iowa and western Illinois. Methods Four dialysis nurses collected information on a prospectively designed data acquisition tool. Patients were randomly assigned to one of two treatment groups, intraperitoneal vancomycin plus oral rifampin or oral trimethoprim/ sulfamethoxazole (TMP/SMX), and their initial antibiotic therapy determined by that assignment. If the infection was gram -negative, the initial antibiotics were discontinued and an alternative therapy begun. Therapy was initiated by the nursing staff and required physician notification within 48 hours. Results There were 126 recorded catheter infections (exit-site, tunnel, or cuff infection) resulting in a rate of 0.67 episodes per patient year of exposure. Staphylococcus aureus was isolated from the majority (60%) of these events. Pseudomonas aeruginosa was the next most common isolate and accounted for 21% of infections. Rubor, dolor, and turgor are the classic signs of inflammation, and at least one of these was present in 79% of the episodes. Isolated pericatheter erythema or serous discharge was associated with a minimal risk «2%) of catheter loss. The presence of a purulent exit-site discharge identified patients who had a 30% chance of failing systemic antibiotic therapy and a 20% risk of catheter loss. The concurrent presence of exit-site tenderness or swelling identified the most severe infections. Staphylococcal infections responded equally well to local cleaning and vancomycin plus rifampin (86% cured) or oral trimethoprim/sulfamethoxazole (89% cured) therapy. Gram-negative infections were frequent (27%) and appeared to respond best to a combination of tobramycin and ciprofloxacin. Conclusion Exit-site/tunnel inflammation is detectable by patients and can be used to guide therapy. An isolated finding of erythema or serous discharge is not indicative of an acute infection and may not require systemic antibiotics. The presence of purulence identifies patients at risk for catheter loss, and these patients benefit from systemic therapy. The combination of a purulent exit-site discharge plus pericatheter tenderness or swelling identifies patients likely to suffer treatment failure and require subsequent catheter removal. The cure rate of gram -positive catheter infections treated with vancomycin plus rifampin was indistinguishable from that achieved with oral trimethoprim/sulfamethoxazole (p = 0.99).

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