Repair of Chronic Peritoneal Dialysis Catheter

Abstract

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.

Creating and Maintaining Optimal Peritoneal Dialysis Access in the Adult Patient: 2019 Update

“…Damage to the external catheter tubing may result from sharp instrument cuts or punctures, fracture from crushing clamps, catheter adapter tears, or chemical destruction of the catheter material from antibiotic ointments or organic solvents. External splicing repair by the PD nursing staff using commercially available repair kits is possible if at least 2 cm of tubing is present beyond the exit site (185). Catheter damage with leak is considered a contaminating event, and investigation for peritonitis is required and prophylactic antibiotics indicated.…”

Catheter salvage using revision for a peritoneal dialysis catheter with intractable exit site and/or tunnel infections

“…However, these problems may be significantly attenuated by the replacement of a significant part of the catheter segment including a new external cuff. Previous studies presented methods for replacement of the catheter segment 12–14 . Asif et al reported a catheter repair method using a connector, while another study showed replacement of catheter segment using a beta‐cap adapter from a PD catheter set 13,14 …”

Repair of ruptured peritoneal dialysis catheter using a new manipulated material

“…The PD catheter was maintained without complications for the next 6 months between post‐operation and the time of last outpatient department visit. Many practitioners may plan removal of the original catheter and reinsertion of a new PD catheter in the absence of a kit for repair of the PD catheter 2 . Our case shows that repair of the PD catheter using this manipulated material may be helpful to salvage intramural and internal segments without an additional repair kit for a PD catheter ruptured in its external segment.…”