The CARI guidelines. Evidence for peritonitis treatment and prophylaxis: indications for the removal of peritoneal dialysis catheters.

Abstract

NephrologyVolume 9, Issue S3 p. S54-S55 Free Access 4. Indications for the removal of peritoneal dialysis catheters First published: 06 October 2004 https://doi.org/10.1111/j.1440-1797.2004.00299.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat GUIDELINES No recommendations possible BACKGROUND The catheters that patients use to receive peritoneal dialysis (PD) require removal from time to time. The purpose of this guideline is to define the circumstances under which the removal of a PD catheter is justified. SEARCH STRATEGY Databases searched: 1 PD and Catheter Removal: MeSH terms and text words for peritoneal dialysis were combined using ‘and’ with MeSH terms and text words for catheters as well as with MeSH terms and text words for peritonitis. These were then combined using ‘and’ with MeSH terms and text words for prognostic studies. Then finally these were combined using ‘and’ with MeSH terms and text words for removal. The search was carried out in Medline (1966 – October Week 5 2002). The Cochrane Renal Group Trials Register was also searched for trials not indexed in Medline. 2 PD and Catheter Replacement: MeSH terms and text words for peritoneal dialysis were combined using ‘and’ with MeSH terms and text words for catheters as well as with MeSH terms and text words for peritonitis. These were then combined using ‘and’ with MeSH terms and text words for prognostic studies. Then finally these were combined using ‘and’ with MeSH terms and text words for replacement. The search was carried out in Medline (1966 – October Week 5 2002). The Cochrane Renal Group Trials Register was also searched for trials not indexed in Medline. Date of searches: 26 November 2002. WHAT IS THE EVIDENCE? No properly conducted randomised controlled trials appear to have been performed that address this issue. SUMMARY OF THE EVIDENCE Not possible. SUGGESTIONS FOR CLINICAL CARE (Suggestions are based on Level III and IV evidence) • Removal of a PD catheter should be considered in those situations which investigators have previously anecdotally reported the removal of PD catheters. These include obstruction to flow, dislodgement, leakage, adjacent herniation, associated infection that fails to respond to antibiotics (including peritonitis, tunnel infection, and exit site infection), spontaneous cuff extrusion, accidental shortening, and discontinuation of PD (including after recovery of renal function, transfer to haemodialysis or renal transplantation). (Level IV evidence) WHAT DO THE OTHER GUIDELINES SAY? Kidney Disease Outcomes Quality Initiative: No recommendation. British Renal Association: No recommendation. Canadian Society of Nephrology: No recommendation. European Best Practice Guidelines: Guideline 3.11 states: Catheter removal for exit-site infection should be considered when: (1) a peritonitis episode with the same microorganism is present, (2) unsuccessful antibiotic treatment, (3) recurrent exit site infections (Evidence C: Opinion).1 International Guidelines: Adults: In patients with multiple gram-negative microorganisms, a high relapse rate is common even with adequate antibiotic therapy. Therefore, even in episodes with initial clinical improvement, removal of the catheter should be considered. If no clinical response is noted after 96 hours of therapy for relapsing peritonitis, catheter removal is indicated. If the patient responds clinically, but subsequently relapses an additional time, catheter removal and replacement are recommended.2 Pediatric patients: Guideline 12: Peritoneal dialysis catheter removal should occur as part of the recommended treatment course in situations in which failure to do so is unlikely to result in successful peritonitis therapy. The timing of catheter replacement should be 2–3 weeks following catheter removal in most cases.3 IMPLEMENTATION AND AUDIT Not possible. SUGGESTIONS FOR FUTURE RESEARCH A prospective multicentre trial could investigate catheter removal after various courses of antibiotics for various types of PD-associated infection. REFERENCES 1 Krediet R, Dombros N, Dratwa M et al. European Guidelines on Best Practice for the Management of Peritoneal Dialysis. European Renal Association, 2002. Google Scholar 2 Keane WF, Bailie GR, Boeschoten E et al. ISPD Guidelines/Recommendations: Adult peritoneal dialysis-related peritonitis treatment recommendations: 2000 update. Perit. Dial. Int. 2000; 20: 396– 411. CASPubMedWeb of Science®Google Scholar 3 Warady BA, Schaefer F, Holloway M et al. ISPD Guidelines/Recommendations: Consensus guidelines for the treatment of peritonitis in pediatric patients receiving peritoneal dialysis. Perit. Dial. Int.,2000; 20: 610– 24. CASPubMedWeb of Science®Google Scholar Volume9, IssueS3October 2004Pages S54-S55 ReferencesRelatedInformation