Effect in a Rat Model of Heparinized Peritoneal Dialysis Catheters on Bacterial Colonization and the Healing of the Exit Site

2001 ◽  
Vol 21 (3_suppl) ◽  
pp. 357-358 ◽  
Author(s):  
Yong-Lim Kim ◽  
Seong Cho ◽  
Jun-Chul Kim ◽  
Dong-Kyu Cho ◽  
Yong-Jin Kim ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Bacterial Colonization ◽  
Randomized Study ◽  
Sprague Dawley ◽  
Exit Site ◽  
Double Blind ◽  
Polymeric Surfaces ◽  
Sprague Dawley Rats ◽  
Multipoint Method ◽  
Catheter Tip

We performed a prospective, double-blind, randomized study to evaluate whether stable surface heparinization of silicone peritoneal dialysis (PD) catheters prevents bacterial colonization or biofilm formation and improves healing of the exit site. Heparinized catheters were implanted in 20 Sprague–Dawley rats (group H) and non heparinized catheters in another 20 (group C). The PD catheters, constructed of silicon tubing with two polyester cuffs, were patterned after the standard Tenckhoff catheter. A covalent multipoint method of attachment onto polymeric surfaces was used for stable, permanent chemical immobilization of heparin on the PD catheter. Dialysis exchanges (25-mL instillation volume) were performed twice daily for 4 weeks through the permanent catheter. Prophylactic antibiotics were not used. The exit sites were evaluated at 2-week intervals. The extent of biofilm coverage on the intraperitoneal portion of the catheter (obtained at the end of the experiment) was assessed, and sonicated fluid from the catheter tip was cultured for evaluating bacterial colonization of the catheter. Exit-site scores in group H were lower than in group C ( p = 0.052) at the end of week 4. Bacterial colonization tended to be less common in group H [2 of 12 catheters (17%)] than in group C [8 of 15 catheters (53%); p = 0.058], but the extent of biofilm, the peritonitis rate, and the inflammation score of tissue adjacent to the cuff were not different between the groups. Those data suggest that heparinized PD catheters can be a practical approach to the prevention of bacterial colonization and can improve healing of the exit site.

The Effect of Antibiotic Prophylaxis on the Healing of Exit Sites of Peritoneal Dialysis Catheters in Rats

1998 ◽  
Vol 18 (1) ◽  
pp. 60-63 ◽  
Author(s):  
Roberto F.S. Pecoits-Filho ◽  
Zbylut J. Twardowski ◽  
Ramesh Khanna ◽  
Yong-Lim Kim ◽  
Sharad Goel ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Antibiotic Prophylaxis ◽  
Sprague Dawley ◽  
Exit Site ◽  
Sprague Dawley Rats ◽  
Group A ◽  
Catheter Implantation ◽  
The Mean ◽  
Group B

Objective To evaluate the influence of intraperitoneal (IP) antibiotic (AB) prophylaxis on the quality of healing and infection rates of exit sites in peritoneal dialysis catheters. Study Design Twenty-one Sprague-Dawley rats were dialyzed 3 times per day for 6 weeks. Dianeal solution containing AB was used for all the rats during the first 5 days. The animals were randomized on the sixth day into three groups: group A (AB-free after randomization), group B (AB for 3 weeks), and group C (AB during 6 weeks). Scores were given to each exit site according to the observation. Mean scores from each group were compared in an attempt to find significant differences between the groups. Dialysate and exit-site drainage samples were taken weekly for microbiology. Results Eight episodes of peritonitis were diagnosed, six in group A and two in group B. The most common bacteria causing peritonitis were gram-negative rods. The mean scores were not significantly different between groups C and B throughout the study, even after the discontinuation of the prophylaxis. Group A, when compared to the other two groups, had significantly higher scores after the second week and throughout the rest of the study. Conclusion Intraperitoneal antibiotic prophylaxis for 3 weeks after catheter implantation is an effective way to prevent early colonization of exit sites, providing a better healing quality and lower incidence of catheter-related infection. Although the extension of the prophylaxis for 6 weeks seems to be beneficial, it was not statistically proven in this study.

Colonization-Resistant Antimicrobial-Coated Peritoneal Dialysis Catheters: Evaluation in a Newly Developed Rat Model of Persistent Pseudomonas Aeruginosa Peritonitis

2002 ◽  
Vol 22 (1) ◽  
pp. 27-31 ◽  
Author(s):  
Anthony Finelli ◽  
Lori L. Burrows ◽  
Frank A. DiCosmo ◽  
Valerio DiTizio ◽  
Selva Sinnadurai ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Peritoneal Dialysis ◽  
Rat Model ◽  
Bacterial Colonization ◽  
Blood Cultures ◽  
Sprague Dawley ◽  
Sprague Dawley Rats ◽  
Colony Forming Units ◽  
Peritoneal Washings ◽  
Culture Positive

Objective Development of a rat model of persistent peritonitis and evaluation of the ability of liposomal ciprofloxacin hydrogel-coated silicone to resist colonization. Design A newly developed model of persistent Pseudomonas aeruginosa peritonitis to compare the ability of liposomal ciprofloxacin hydrogel (LCH)-coated silicone versus plain silicone for resistance to bacterial colonization. Animals Male Sprague–Dawley rats. Results Inoculating the peritoneum of rats with 1 mL 0.5% agar containing 106 colony-forming units (cfu)/mL P. aeruginosa in the presence of a plain silicone coupon resulted in persistent peritonitis for at least 7 days. Plain silicone coupons in all 40 rats were colonized (median 2.54 × 103 cfu/cm2; range 5.0 × 101 – 1.0 × 106 cfu/cm2) and peritoneal washings were consistently culture-positive. In contrast, the LCH coupons removed after 7 days from the 40 test rats were sterile, as were the peritoneal washings, and there was no evidence of peritonitis. Blood cultures were negative in both groups. Conclusions Liposomal ciprofloxacin hydrogel-coated silicone resists colonization in this rat model of persistent P. aeruginosa peritonitis.

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

1985 ◽  
Vol 5 (4) ◽  
pp. 219-223 ◽  
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.

Catheter Configuration and Outcome in Patients on Continuous Ambulatory Peritoneal Dialysis: A Prospective Comparison of Two Catheters

1994 ◽  
Vol 14 (1) ◽  
pp. 70-74 ◽  
Author(s):  
Björn H. Eklund ◽  
Eero O. Honkanen ◽  
Aino-Riitta Kala ◽  
Lauri E. Kyllönen
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Infectious Complications ◽  
University Hospital ◽  
Exit Site ◽  
Catheter Survival ◽  
Tenckhoff Catheter ◽  
Prospective Comparison ◽  
Catheter Tip ◽  
The Impact

Objective To examine the impact of peritoneal catheter configuration on mechanical complications, catheter survival, probability of episodes of peritonitis, and probability of exit-site infections associated with the use of catheters for continuous ambulatory peritoneal dialysis (CAPD). Design Prospective randomized trial. Setting CAPD unit in one university hospital. Patients Forty consecutive patients requiring a dialysis catheter for future CAPD were randomized to receive either a single-cuff straight Tenckhoff catheter or a permanently bent single-cuff Swan neck catheter. The skin exit was upward-directed in the Tenckhoff group and downward-directed in the Swan neck group. Results Dialysate leak occurred in one patient and symptomatic catheter tip migration in 3 patients with the Tenckhoff catheter but in none with the single-cuff Swan neckcatheter(p=O.5, p=0.12). No significant differences in catheter survival at 2 years, probability of episodes of peritonitis, or probability of exit-site infections could be demonstrated. Conclusion Catheter configuration did not influence the catheter-related mechanical or infectious complications. We were unable to demonstrate any advantage of the newer, permanently bent single-cuff Swan neck catheter over the conventional straight type.

scholarly journals Comparative Effectiveness of Local Application of Chlorhexidine Gluconate, Mupirocin Ointment, and Normal Saline for the Prevention of Peritoneal Dialysis-related Infections (COSMO-PD Trial): a multicenter randomized, double-blind, controlled protocol

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Surapon Nochaiwong ◽  
◽  
Chidchanok Ruengorn ◽  
Kajohnsak Noppakun ◽  
Setthapon Panyathong ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Cost Effectiveness ◽  
Normal Saline ◽  
Cost Utility ◽  
Chlorhexidine Gluconate ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Exit Site ◽  
Double Blind ◽  
Mupirocin Ointment

Abstract Background Current international guidelines recommend the use of a daily topical exit-site antimicrobial to prevent peritoneal dialysis (PD)-related infections. Although nonantibiotic-based therapies are appealing because they may limit antimicrobial resistance, no controlled trials have been conducted to compare topical antimicrobial agents with usual exit-site care for the prevention of PD-related infections among the Thai PD population. We propose a controlled three-arm trial to examine the efficacy and safety of a daily chlorhexidine gluconate-impregnated patch versus mupirocin ointment versus usual exit-site care with normal saline for the prevention of PD-related infections. Methods/Designs This study is a randomized, double-blind, multicenter, active-controlled, clinical trial. Adult patients aged 18 years or older who have end-stage kidney disease and are undergoing PD will be enrolled at three PD Centers in Thailand. A total of 354 PD patients will be randomly assigned to either the 2% chlorhexidine gluconate-impregnated patch, mupirocin ointment, or usual exit-site care with normal saline dressing according to a computer-generated random allocation sequence. Participants will be followed until discontinuation of PD or completion of 24 months. The primary study outcomes are time to first PD-related infection (exit-site/tunnel infection or peritonitis) event and the overall difference in PD-related infection rates between study arms. Secondary study outcomes will include (i) the rate of infection-related catheter removal and PD technique failure, (ii) rate of nasal and exit-site Staphylococcus aureus colonization, (iii) healthcare costs, and (iv) skin reactions and adverse events. We plan to conduct a cost-utility analysis alongside the trial from the perspectives of patients and society. A Markov simulation model will be used to estimate the total cost and health outcome in terms of quality-adjusted life years (QALYs) over a 20-year time horizon. An incremental cost-effectiveness ratio in Thai Baht and U.S. dollars per QALYs gained will be illustrated. A series of probabilistic sensitivity analyses will be conducted to assess the robustness of the cost-utility analysis findings. Discussion The results from this study will provide new clinical and cost-effectiveness evidence to support the best strategy for the prevention of PD-related infections among the Thai PD population. Trial registration ClinicalTrials.gov, NCT02547103. Registered on September 11, 2015.

scholarly journals Randomized, Double-Blind Trial of Antibiotic Exit Site Cream for Prevention of Exit Site Infection in Peritoneal Dialysis Patients

2004 ◽  
Vol 16 (2) ◽  
pp. 539-545 ◽  
Author(s):  
Judith Bernardini ◽  
Filitsa Bender ◽  
Tracey Florio ◽  
James Sloand ◽  
Linda PalmMontalbano ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Site Infection ◽  
Double Blind Trial ◽  
Dialysis Patients ◽  
Exit Site ◽  
Double Blind ◽  
Exit Site Infection ◽  
Blind Trial

scholarly journals Twin- versus single-bag disconnect systems: infection rates and cost of continuous ambulatory peritoneal dialysis.

1996 ◽  
Vol 7 (11) ◽  
pp. 2392-2398 ◽  
Author(s):  
D C Harris ◽  
E J Yuill ◽  
K Byth ◽  
J R Chapman ◽  
C Hunt
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Randomized Study ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Total Cost ◽  
Purchase Cost ◽  
Fluid Transfer

Although twin-bag disconnect fluid-transfer systems for continuous ambulatory peritoneal dialysis (CAPD) have a lower rate of catheter-related infection than single-bag systems, their greater monetary purchase cost has prevented universal adoption. Therefore, a single-center randomized study was performed in 63 adult patients to compare the efficiency and total cost of Freeline Solo (FS, twin-bag) and Basic Y (BY, single-bag) systems. Patients were new to CAPD (N = 39), or had a new CAPD catheter, or had had no episodes of peritonitis or exit-site infection in the previous 12 months (N = 24). Total follow-up was 631 patient months (pt.mon), and 53 patients were still on the trial at its termination. Patients rated FS as easier to use than BY (P < 0.001). Peritonitis occurred on 23 occasions in 12 out of 30 patients using BY, and on seven occasions in five of 33 patients using FS. Time to first infection was less with BY than FS (hazard ratio, 2.4; 95% confidence interval (CI), 1.0 to 5.3; P < 0.04). Cumulative incidence of peritonitis was 1 per 14.0 pt.mon with BY and 1 per 46.5 pt.mon with FS (odds ratio, 3.6; 95% CI 1.5 to 8.5; P = 0.004). Length of hospitalization for peritonitis or exit-site infection was 98 days in six patients with BY, versus 17 days in two patients with FS. With BY, four catheters were removed because of infection, but none with FS (P < 0.05). With BY, the total cost of infection was $AUD127,079 ($5033 per pt.yr) versus $19,250 ($704 per pt.yr) with FS, which offset the higher purchase cost of FS. The total cost of CAPD was $AUD956 per pt.yr less with FS than BY. In conclusion, the higher purchase cost of the FS twin-bag system is more than offset by savings from its lower incidence of peritonitis.

A Randomized Study Comparing a Transparent Polyurethane Dressing to a Dry Gauze Dressing for Peripheral Intravenous Catheter Sites

1985 ◽  
Vol 6 (9) ◽  
pp. 361-366 ◽  
Author(s):  
Donald E. Craven ◽  
Deborah A. Lichtenberg ◽  
Laureen M. Kunches ◽  
Ann T. McDonough ◽  
Maria I. Gonzalez ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Bacterial Colonization ◽  
Randomized Study ◽  
Insertion Site ◽  
Summer Season ◽  
Coagulase Negative Staphylococci ◽  
Peripheral Intravenous Catheter ◽  
Catheter Tip ◽  
Gauze Dressing ◽  
Therapy Team

AbstractWe studied rates of peripheral intravenous (IV) catheter tip and insertion site colonization after randomly assigning patients to transparent polyurethane (TP) dressings (N=316) or dry gauze (DG) dressings (N=421). The study was conducted during both summer and fall seasons, in a facility which lacked air conditioning. All patients had a teflon plastic catheter inserted, maintained and cultured by a member of the IV therapy team; no antibiotic or antiseptic ointments were used. Colonization rates were higher in the summer than in the fall for both catheter tips (9.0% vs 3.5%, p=0.005) and sites (21.6% vs 7.0%, p=0.001). During the summer season, the rate of catheter tip colonization with TP dressings was nearly twice that of DG dressings (12.4% vs 6.8%, p=0.04). Logistic regression analysis indicated that catheter tip colonization was associated with the summer season (odds ratio=3.0, 95% CI 1.4-6.2) and TP dressings (odds ratio=1.8, 95% CI 1.1-3.2), and that site colonization was associated with both summer (odds ratio=4.0, 95% CI 2.2-7.1) and receipt of antibiotics (odds ratio=1.9, 95% CI 1.1-3.2). Coagulase-negative staphylococci were isolated from 55.5% of the colonized catheter tips and insertion sites. The data suggest that bacterial colonization of peripheral IV catheters is increased in summer, and that use of TP dressings may increase both tip colonization and cost nearly twofold.

scholarly journals Influence on Bone-to-Implant Contact of Non-Thermal Low-Pressure Argon Plasma: An Experimental Study in Rats

2020 ◽  
Vol 10 (9) ◽  
pp. 3069
Author(s):  
Arturo Sanchez-Perez ◽  
Ana I. Nicolas-Silvente ◽  
Carmen Sanchez-Matas ◽  
Fernando Muñoz-Guzon ◽  
Carlos Navarro-Cuellar ◽  
...  
Keyword(s):  
Essential Role ◽  
Histological Analysis ◽  
Bacterial Colonization ◽  
Argon Plasma ◽  
Low Pressure ◽  
Sprague Dawley ◽  
New Techniques ◽  
Implant Placement ◽  
Sprague Dawley Rats ◽  
Bone To Implant Contact

Roughness characteristics play an essential role in osseointegration. However, there is a concern about the susceptibility of those surfaces to bacterial colonization. New techniques for cleaning and surface treatment have appeared that could favor osseointegration without the need to create surfaces as rough. Such is the case of non-thermal low-pressure argon plasma (NTLP-ArP). One hundred and forty-four implants were placed in the tibiae of 36 Sprague Dawley rats, distributed in four experimental groups: I: mechanized surface; II: mechanized surface treated with NTLP-ArP, III: resorbable blast media (RBM) surface; and IV: RBM surface treated with (NTLP-ArP). Bone-to-implant contact (BIC) percentages were calculated by microtomographic evaluation and histological analysis at one, two, and four weeks after implant placement. ANOVA and Mann–Whitney tests were used for statistical analysis, establishing p < 0.05. No significant differences were found at one-week comparisons. The groups treated with NTLP-ArP obtained higher BIC% than those not treated at two and four weeks. Mechanized surfaces treated with NTLP-ArP obtained BIC values similar to RBM surfaces.

Randomized Study of Peritonitis with Conventional versus O-Set Techniques in Continuous Ambulatory Peritoneal Dialysis

1992 ◽  
Vol 12 (2) ◽  
pp. 216-220 ◽  
Author(s):  
Julie E. Owen ◽  
Rowan G. Walker ◽  
Jeannie Lemon ◽  
Liliana Brett ◽  
Danielle Mitrou ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Median Survival Time ◽  
Physical Disabilities ◽  
Randomized Study ◽  
Life Table Analysis ◽  
Conventional System ◽  
Exit Site ◽  
Table Analysis ◽  
Patient Episode

We performed a prospective randomized trial, comparing the incidence of peritonitis between a flushdisconnect (O-System, Baxter, Deerfield, IL) (OS) and a conventional (System II, Baxter) (CS) continuous ambulatory peritoneal dialysis (CAPD) method. Sixty consenting patients with no significant physical disabilities who commenced CAPD after May 1987 were entered and followed for a minimum of 12 months. Thirty were placed on the OS system and 30 were placed on CS. Age, gender, and time for training did not differ significantly. The period of observation for OS was 375 months; CS was observed for 430 months. OS patients experienced 28 episodes of peritonitis (13.4 months/patient/episode) compared with 88 (4.9 months/patient/episode) in CS (p<0.005). By 6 months, 32% of OS patients had had at least one episode of peritonitis, compared with 62% of CS patients; at 12 months, these figures rose to 48% for OS and 91% for CS (p<0.01) patients (Life Table Analysis). The median survival time to first peritonitis episode was 5.1 months in CS and 9.7 months in OS (p<0.01). Exit. site infections occurred in 14/30 (46%) of patients on OS and in 13/30 (43%) of CS patients. We conclude that the OS was associated with a significant reduction in the incidence of peritonitis.

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