Catheter revision for the treatment of intractable exit site infection/tunnel infection in peritoneal dialysis patients: A single centre experience

Cho, Kyu-Hyang; Do, Jun‐Young; Park, Jong-Won; Yoon, Kyung-Woo

doi:10.1111/j.1440-1797.2012.01644.x

Cited by 18 publications

(33 citation statements)

References 33 publications

(125 reference statements)

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“…This approach also resulted in a shorter hospital stay; 7.8 days compared to 25 days in patients who had catheter removal . Furthermore, catheter survival post‐revision for intractable exit‐site and tunnel infections was almost 90% at 1 year suggesting this procedure is associated with a sustained microbiological cure …”

Section: Pd During Peritonitis Exit‐site Infections and Tunnel Infementioning

confidence: 97%

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Reducing intra‐abdominal pressure in peritoneal dialysis patients to avoid transient hemodialysis

Jegatheswaran

Warren

Zimmerman

2018

Seminars in Dialysis

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Patients treated with peritoneal dialysis (PD) are often required to switch to hemodialysis (HD) temporarily when they develop abdominal wall hernias and dialysate leaks, peritonitis or undergo thoracic or abdominal surgeries. There are significant risks associated with incident hemodialysis including possible central venous catheter infections, thrombosis, and need for invasive procedures. Therefore, strategies to avoid temporary transfer to hemodialysis are desirable. The increased intra-abdominal pressure associated with PD is largely responsible for the issues requiring withholding PD. However, the high intra-abdominal pressure, due to dialysate and body position, can be minimized by making changes to the peritoneal dialysis prescription. The lower intra-abdominal pressure may allow dialysate leaks, hernia repairs, and abdominal incisions time to heal as well as to facilitate earlier resumption of PD after catheter replacement. These strategies help to decrease morbidity and minimize cost to the health care system associated with modality switches and its complications.

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Section: Pd During Peritonitis Exit‐site Infections and Tunnel Infementioning

confidence: 97%

“…29 Furthermore, catheter survival post-revision for intractable exit-site and tunnel infections was almost 90% at 1 year suggesting this procedure is associated with a sustained microbiological cure. 30…”

Section: Infections and Tunne L Infectionsmentioning

confidence: 99%

Reducing intra‐abdominal pressure in peritoneal dialysis patients to avoid transient hemodialysis

Jegatheswaran

Warren

Zimmerman

2018

Seminars in Dialysis

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“…It may be reasonable to differentiate catheter related infections in exit site/tunnel infection and catheter-related blood stream infection. The term ‘exit site infection’ is well known in peritoneal dialysis patients [ 2 ]. Alcohol consumption, smoking, a low level of education, cultural factors, underlying disease, and the type of venous access are considered to be factors potentially contributing to the development of such complications [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…The term ‘exit site infection’ is well known in peritoneal dialysis patients [ 2 ]. Alcohol consumption, smoking, a low level of education, cultural factors, underlying disease, and the type of venous access are considered to be factors potentially contributing to the development of such complications [ 2 , 3 ]. Tunnelled CVCs with antiseptic coating are effective in preventing infections [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

A comparison of two methods of treatment for central catheter tunnel phlegmon in home parenteral nutrition patients

Ławiński¹,

Forysiński²,

Bzikowska³

et al. 2016

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IntroductionThe ESPEN guidelines on long-term (> 3 months) parenteral nutrition recommend the use of tunnelled central venous catheters (CVCs) to minimise the risk of insertion site infection. A developed symptomatic infection of the soft tissue tunnel surrounding a CVC may rapidly become directly life threatening if the infection progresses along the catheter tunnel towards its end inserted into the venous system. This requires immediate management to eliminate infection and limit its effects.AimTo compare two surgical techniques for the treatment of suppurative inflammation of a CVC tunnel: conventional drainage of the infected tissues (surgical technique A) vs. radical en bloc excision of the infected tissues together with the infected central catheter (surgical technique B).Material and methodsSeventy-three patients hospitalised due to CVC tunnel phlegmon between April 2004 and May 2014 were included in the retrospective study. Thirty-four (46.5%) patients underwent surgical procedure A and another 39 (53.5%) underwent procedure B.ResultsThe mean duration of antibiotic therapy following procedure A was 8 ±3 days, whereas procedure B required 7 ±2 days of antibiotic therapy (NS). The mean hospitalisation period following procedure B was over 8 days shorter in comparison to that following procedure A (16.54 ±7.59 vs. 24.87 ±10.19, p = 0.009, respectively).ConclusionsThe surgical treatment of CVC tunnel phlegmon involving radical en bloc excision of suppurated tissues along with the infected CVC shortens hospitalisation, expedites the insertion of a new CVC, and potentially reduces treatment costs.

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“…Resistant exit site infection (ESI), found in 36 of 126 PD patients with ESI, was treated with catheter revision (new tunnel and ES) rather than catheter removal . Catheter survival rate was 90% at 1 year.…”

mentioning

confidence: 99%

Briefly Noted

Sherman¹

2013

Seminars in Dialysis

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Reanalysis of HEMO study data found that when the dialysis dose (Kt) was normalized to body surface area (SA) rather than body water (V), the higher mean dose received by women (Kt/V 1.7) compared with men (1.5) was reversed-women received less dialysis (2.3 vs. 2.5 SA normalized Kt/ V). This may explain why women but not men benefited from Kt/V levels >1.6-1.7.• HD patients receiving less than 240 minutes of dialysis thrice weekly had a 26% higher risk of death than those receiving 240 minutes or more of treatment according to an analysis of 14,643 patients in a large dialysis organization. Patients were pair matched for weight, age, gender, and access type (2).

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Catheter revision for the treatment of intractable exit site infection/tunnel infection in peritoneal dialysis patients: A single centre experience

Cited by 18 publications

References 33 publications

Reducing intra‐abdominal pressure in peritoneal dialysis patients to avoid transient hemodialysis

Reducing intra‐abdominal pressure in peritoneal dialysis patients to avoid transient hemodialysis

A comparison of two methods of treatment for central catheter tunnel phlegmon in home parenteral nutrition patients

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