Chronic Peritoneal Dialysis Catheters Research Articles

Peritoneal dialysis in children: Infectious and mechanical complications: Experience of a tertiary hospital in Elazığ, Turkey.

Peritoneal dialysis (PD) is frequently used in pediatric patients with renal failure. In the present study, we evaluated the indications and complications of PD and patients' outcomes in pediatric patients. Medical records of patients who underwent PD between 2012 and 2019 were analyzed retrospectively. The patients were divided into two groups as acute PD (APD) (Group 1) and chronic PD (CPD) (Group 2). If the patient was diagnosed with acute kidney injury (AKI), an APD catheter was inserted, while a CPD catheter was inserted for patients with stage 5 chronic renal failure or those in which AKI persisted for more than 6 weeks. Group 1 and Group 2 consisted of 62 and 64 patients, respectively. The most common indications for PD were AKI (64.5%) in Group 1, and obstructive uropathy and reflux nephropathy (45.3%) in Group 2. The overall complication rate was 30%. These were leakage at the catheter insertion site (11.2%), catheter occlusion (4.8%), and peritonitis (4.8%) in Group 1; and peritonitis (14.1%), catheter occlusion (6.2%), and inguinal hernia (4.6%) in Group 2. The mortality rate was 72.5% and 23.4% in Group 1 and Group 2, respectively. The most common causes of mortality were multisystem organ failure (40%) and sepsis (33.5%) in both groups. A total of 83 patients (32 in Group 1 and 51 in Group 2) had omentectomy. Catheter revision and/or removal were performed in 11.9% of all patients. Omentectomy had no effect on the prevention of catheter occlusion (p > 0.05). The mortality rate is lower in CPD patients than in APD patients. Although PD in pediatric patients is associated with potential complications, its actual rate is relatively low. The primary catheter dysfunction rate is low, and omentectomy has no significant effect on preventing catheter occlusion.

POS-630 DROP-OUT OF CHILDREN WITH ESKD FROM CHRONIC PERITONEAL DIALYSIS AND ASSOCIATED FACTORS, A TEN YEAR REVIEW AT RED CROSS WAR MEMORIAL CHILDREN’S HOSPITAL, SOUTH AFRICA

Dialysis is a temporary kidney replacement therapy to keep children who develop end stage kidney disease (ESKD) healthy and alive while work up for kidney transplant, the preferred treatment, proceeds. Kidney transplantation may be preemptive. Chronic peritoneal dialysis (PD) is the preferred modality over hemodialysis (HD) in children because of the convenience of dialysis being performed at home as opposed to hospital visits for HD, avoids problems associated with vascular access and children face fewer school interruptions. Children may drop-out from PD due to complications and permanently switch to HD or die before being transplanted. We sought to investigate the rate of drop-out among children on chronic PD and describe some contributing factors. This was a retrospective descriptive study involving children entered onto the kidney transplant waiting list from 2009 to 2018. We recruited children who were on chronic PD over the 10 year study period. Drop-out was defined as permanent switch to HD or death while on PD. Relevant data was extracted from patient folders following ethical approval. Outcome measures were proportion of children dropping-out, factors associated with drop-out and timing of drop-out. A total of 111 children were listed for transplantation between January 2009 and December 2018, 67 were treated with PD (of whom 18 had previously been treated with HD) and 11 were treated with HD alone. Thirty three (33) children were not on any dialysis modality and either received preemptive kidney transplantation or remained on the waiting list at the end of the study period. Complete data was available for 52 of the 67 children who received PD. There were 25 (48%) females. The median age of all participants was 11 (interquartile range 6.0, 13.1) years. Forty seven (90%) children were cared for by parents. Chronic PD catheters were inserted laparoscopically in 90% of the children. The most frequent causes of ESKD were steroid resistant nephrotic syndrome (13%) and posterior urethral valves (12%) (Figure 1).The peritonitis rate was 1.2 episodes per patient year. Twenty two (42.3%) children had no episodes of peritonitis. The median duration of PD overall was 9 (range 1-60) months. The median duration of PD until transplantation was 11 months (interquartile range 6, 24.5), compared with 4 months (interquartile range 2, 14) among those who dropped-out of PD. At the end of the study period, 17/52 children (32.7%) dropped-out of PD before transplantation, with 13 (25%) switches to HD and 4 (7.6 %) deaths, while 29 were transplanted and 6 still on PD (35/52). One or more episodes of bacterial peritonitis was significantly associated with drop-out from PD (p = 0.017) (Table 1). Three deaths were directly related to PD complications and one was a result of pancytopenia. Switch to HD was mostly due to peritonitis complications. Over half of the children dropped-out within the first 12 months of PD (Table 2). Table 1. Factors associated with drop-out from PDView Large Image Figure ViewerDownload Hi-res image Download (PPT)Table 2: Description of the cases that dropped-out from PD and the timing of drop-out.View Large Image Figure ViewerDownload Hi-res image Download (PPT) We observed a high drop-out rate of 32.7% from chronic PD among children awaiting kidney transplantation at RCWMCH. There is a need to improve measures to prevent peritonitis to improve retention rates on chronic PD. Further prospective studies are required to better monitor peritonitis rates.

Delayed Rectal Perforation: A Rare Complication of Chronic Peritoneal Dialysis Catheter in Pediatrics and Its Treatment without Exploration.

Delayed Rectal Perforation: A Rare Complication of Chronic Peritoneal Dialysis Catheter in Pediatrics and Its Treatment without Exploration.

An Unusual Case of Peritoneal Dialysis Twisted Catheter in a Child

Objective: Mechanical complications of peritoneal dialysis (PD) may occur because of surgical complications when inserting a Tenckhoff catheter or non-surgical complications during chronic care of a PD catheter. We aim to highlight the latter by presenting a case report of twisted external catheter. Method: We report an 11-year-old Indonesian girl with end-stage renal disease on continuous ambulatory PD at Cipto Mangunkusumo Hospital who was hospitalized due to repeat peritonitis.Result: Upon examination, the external catheter seemed twisted without inflow, outflow, or ultrafiltration problems. Her exit score was 4 with gaping. Both abdominal X-ray and ultrasound showed that the catheter and its cuffs were properly placed. The patient frequently pulled and manipulated her PD catheter. Additionally, the catheter-site care procedure was frequently done by untrained caregivers and catheter fixation was also not performed. A retraining program for all involved caregivers was carried out. Peritonitis resolved after 14-day-treatment using intraperitoneal gentamicin. We determined that the twisted catheter and repeat peritonitis were due to a combination of mechanical trauma, poor chronic catheter-site care, and suboptimal PD catheter training. Conclusion: Maintaining compliance for chronic PD catheter exit-site care by well-trained caregivers and by patients themselves, as well as the external catheter fixation are important.

Effective Laparoscopic Catheter Insertion Technique for Peritoneal Dialysis Using Specially Designed Trocar: 22 Years Multi-Center Retrospective Study of 804 Patients

Introduction: Literature reveals several peritoneal dialysis laparoscopic catheter insertion techniques developed to improve long-term results for treatment chronic kidney failure with the technic of peritoneal dialysis. The purpose of the study is evaluation of developed and recommended minimally invasive laparoscopic technic for chronic peritoneal dialysis catheter placement using specially constructed trocar. Materials and Methods: Retrospective study included 804 patients in 10 departments of surgery. Surgical and non surgical complications related to PD catheter placement were analysed: bleeding, dialysate leak, early SSI, peritonitis, catheter tip migration, catheter obstruction, omental wrapping and visceral perforations. Available software (Microsoft® Excel for Windows 10, MedCalc, Mariakerke, Belgium) was used for statistical analysis (presented as percentages, mean ± SD or median). Conclusions: The presented technique with specially constructed trocar is a simple and effective procedure with fewer complications comparing to literature. The advantages of this method include long rectus sheath tunnel with the deep cuff placed pre-peritoneally, the small size of the entrance into the peritoneum and accurate position and control of catheter tip in the pelvis.

Epidemiology of peritonitis following maintenance peritoneal dialysis catheter placement during infancy: a report of the SCOPE collaborative.

Maintenance peritoneal dialysis (PD) is the dialysis modality of choice for infants and young children. However, there are limited outcome data for those who undergo PD catheter insertion and initiate maintenance PD within the first year of life. Using data from the Children's Hospital Association's Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (ESRD) Collaborative (SCOPE), we examined peritonitis rates and patient survival in 156 infants from 29 North American pediatric dialysis centers who had a chronic PD catheter placed prior to their first birthday. In-hospital and overall annualized rates of peritonitis were 1.73 and 0.76 episodes per patient-year, respectively. Polycystic kidney disease was the most frequent renal diagnosis and pulmonary hypoplasia the most common co-morbidity in infants with peritonitis. Multivariable regression models demonstrated that nephrectomy at or prior to PD catheter placement and G-tube insertion after catheter placement were associated with a nearly sixfold and nearly threefold increased risk of peritonitis, respectively. Infants with peritonitis had longer initial hospital stays and lower overall survival (86.3 vs. 95.6%, respectively; P<0.02) than those without an episode of peritonitis. In this large cohort of infants with ESRD, the frequency of peritonitis was high and several risk factors associated with the development of peritonitis were identified. Given that peritonitis was associated with a longer duration of initial hospitalization and increased mortality, increased attention to the potentially modifiable risk factors for infection is needed.

Chronic peritoneal dialysis in children: the role of ultrasound in the diagnosis of peritoneal catheter obstruction.

Over the past two decades, continuous ambulatory peritoneal dialysis has emerged as the first-choice dialysis modality in children awaiting for transplantation. Despite the improvements observed in catheter survival over the past several years, the obstruction is one of the reasons for immediate catheter non-function. This study assessed usefulness of ultrasound (US) in visualizing the obstruction of chronic peritoneal dialysis (CPD) catheter and identifying the etiology. Between January 2000 and November 2012, 38 patients (20 M, 18 F) were treated with CPD and examined with US. The type of catheter in all subjects was the straight two-cuff Tenckhoff catheter. We evaluated the typical sonographic signs of the most common CPD catheter complications. We had 12/38 cases with catheter malfunction due to its obstruction. In eight patients, US showed the presence of echogenic material fragmented into the lumen and around the distal tip of the catheter. In the other four patients, US demonstrated the displacement of catheter in bowel loops and an amorphous material as homogeneous echoic area around the distal tip. Our results confirm the effectiveness of US in the assessment of the complications related to intraperitoneal catheters. US is able to identify the catheter obstruction and recognize the etiology (endoluminal strands of fibrin, other materials or the omental wrapping), facilitating a correct therapeutic approach.

Peritoneal Dialysis in Extremely Low Birth Weight Baby using Chronic PD Catheter

Acute kidney injury (AKI) and fluid overload are serious and common complication in premature babies and may increase morbidity and mortality. Renal replacement therapy should be considered for babies who fail medical interventions. Peritoneal dialysis (PD) is considered a safe and practical option for premature infants by producing efficient gentle removal of solutes and excessive water. There are few reports of PD done in extremely low birth weight (ELBW) infants. Acute PD catheters commonly used in children are reported to have more complications thus seldom used in premature babies. Several authors report using regular intravenous or central venous catheters to dialyze premature babies. We describe an ELBW (700g, twin A) infant born at 24 weeks gestation, who was dialyzed on the 34th day (910g) via pediatric size chronic PD catheter. Filling and drainage of PD fluid were performed manually. We encountered few complications and they were easily controlled. The dialysis resulted in normalization of serum creatinine and correction of fluid and electrolyte imbalance within 10 days. The infant continued to grow and eventually was discharged in good condition, with normal renal function at an adjusted age of 40 weeks (term).

Single port laparoscopic and open surgical accesses of chronic peritoneal dialysis in children: A single center experience over 12 years.

INTRODUCTION:The aim of this study was to evaluate patients with end stage renal failure (ESRD) who underwent chronic peritoneal dialysis (CPD). The clinical outcomes of laparoscopic and open placements of catheters were compared.MATERIALS AND METHODS:We reviewed 49 (18 male and 31 female) children with CPD according to age, sex, cause of ESRD, catheter insertion method, kt/V rate, complications, presence of peritonitis, catheter survival rate between January 2002 and February 2014.RESULTS:Thirty-three patients were with open placement and 16 patients were with laparoscopic placement. The rate of the peritonitis is significantly less in patients with laparoscopic access than open access (n = 4 vs n = 25) (P <0.01). Patients with peritonitis were younger than those who had no attack of peritonitis (10.95 ± 0.8 years vs 13.4 ± 0.85 years). According to the development of complications, significant difference has not been found between the open (n = 9) and laparoscopic (n = 3) approaches except the peritonitis. Catheter survival rate for the first year was 95%, and for five years was 87.5%. There was no difference between open and laparoscopic group according to catheter survival rate. The mean kt/V which indicates the effectiveness of peritoneal dialysis was mean 2.26 ± 0.08. No difference was found between laparoscopic and open methods according to kt/V.CONCLUSION:Laparoscopic placement of CPD results in lower peritonitis rate. Catheter survival rate was excellent in both groups. Single port laparoscopic access for CPD catheter insertion is an effective and safe method.

Peritoneal Dialysis Catheter Insertion by Interventional Nephrologists

Peritoneal dialysis (PD) catheter placement is performed by surgeons, interventional radiologists, and interventional nephrologists. Catheter insertion is accomplished through various methods including open surgical technique and laparoscopic, peritoneoscopic, and fluoroscopic guidance. Complication rates and catheter survival can vary based on the insertion technique used. Recently, nephrologists have made significant advances in the area of peritoneal dialysis catheter design and placement. Current data suggest that nephrologists are increasingly placing PD catheters using peritoneoscopic and fluoroscopic technique. This review focuses on peritoneoscopic and fluoroscopic insertion and highlights the advantages of catheter insertion by nephrologists.

A ten-year single-centre experience in children on chronic peritoneal dialysis--significance of percutaneous placement of peritoneal dialysis catheters

Chronic peritoneal dialysis (CPD) in children is an important modality of renal replacement therapy. The ideal method for inserting CPD catheters remains still controversial. Minimal invasive techniques are becoming more popular. This study was performed in order to evaluate the efficiency, the complication profile and the survey of percutaneously placed CPD catheters in children, retrospectively. This study was carried out on 108 peritoneal catheters implanted in 93 patients (45 girls, 48 boys), aged 8.0+/-4.2 years (range: 3 months to 16 years) during the period between December 1995 and November 2005. In the study group, 32 children were transplanted, 15 were transferred to haemodialysis and 18 patients died. All catheters implanted by percutaneous route were Tenckhoff swan-neck double-cuff paediatric catheters. Placement procedure was performed in our unit by us. Statistical analysis was made by chi-square and Kaplan-Meier methods. During 2670 CPD months we observed a total of 108 catheter-related complications: 82 catheter infections including exit-site and/or tunnel infection (1/32.5 patient-months), 10 dislocations, six drainage problems and six kinks. The incidence of all complications was one complication every 24.72 dialysis months. Overall, the incidence of peritonitis was one episode per 18.1 patient-months. Pseudomonas spp. and Staphylococcus aureus were the two most common causes of infections. Fifteen catheters were removed due to catheter-related causes: drainage problems (six patients), catheter dislocation (three patients), omental capture (two patients) kink (two patients) and tunnel infection (two patients). The catheter survival rate was 92.4% at 1 year, 83% at 2 years and 63% at 10 years; patient survival in the 93 children was 91% at 1 year, 84% at 2 years and 48% at 10 years. Younger patients were at increased risk of exit-site and tunnel infections (P<0.05) but the difference in catheter survival time between the age groups was not significant (P>0.05). In complications, no statistical difference was observed between early and delayed catheter use groups (P>0.05). We compared the two periods (period 1, December 1995 to November 2000; period 2, December 2000 to November 2005), for complications of CPD. The risk of catheter migration was greater in period 1 than in period 2 (P=0.04). The percutaneous technique performed by experienced nephrologists is a reliable, safe and cost-effective method for placement of PD catheters. In our opinion, the skill for CPD catheter placement must be part of the paediatric nephrologist training.

Selected best demonstrated practices in peritoneal dialysis access

Many burdensome interventions that adversely affect the utilization of peritoneal dialysis as renal replacement therapy and patient satisfaction with this treatment modality can be avoided by early peritoneal access placement with embedded catheters, implantation techniques that preempt common catheter complications, and the use of access devices that provide flexibility in exit site location. Catheter embedding consists of subcutaneously burying the external limb of the catheter tubing at the time of the insertion procedure. Interval exteriorization of the catheter is performed when dialysis is needed. Earlier commitment by patients to peritoneal dialysis can be achieved by elimination of catheter maintenance until dialysis is necessary. Catheter embedding is a practical strategy to avoid temporary hemodialysis with vascular catheters and reduces stress on operating room access by allowing more efficient scheduling as non-urgent procedures. Laparoscopic catheter placement enables proactive techniques not available to other conventional insertion methods. These techniques include rectus sheath tunneling to prevent catheter tip migration, selective prophylactic omentopexy to prevent omental entrapment, selective resection of epiploic appendages to prevent catheter obstruction, adhesiolysis to eliminate compartmentalization, and diagnosis and simultaneous repair of previously undiagnosed abdominal wall hernias. Both standard and extended 2-piece catheter systems are necessary to customize the peritoneal access to a variety of body configurations. Catheters should be able to produce lower abdominal, mid-abdominal, upper abdominal, and upper chest exit site locations that facilitate management by the patient without sacrificing deep pelvic position of the catheter tip or resulting in excessive tubing stress during passage through the abdominal wall.

Chronic Peritoneal Dialysis Catheters: Challenges and Design Solutions

Although highly successful as transcutaneous access devices, today's peritoneal dialysis catheters still have imperfect hydraulic function, biocompatibility and resistance to infection. Success of Tenckhoff catheters is greatly improved by the proper positioning of deep and subcutaneous cuffs and intraperitoneal segment. Newer peritoneal catheter designs are intended to improve hydraulic function, avoid outflow failure, and diminish exit site infection. These catheter designs serve as excellent alternatives for patients with various types of failure of Tenckhoff catheters. Catheters have been designed for Continuous Flow Peritoneal Dialysis, and have generally been successful in providing high peritoneal dialysis flow rate, but not always successful in optimally distributing flow of peritoneal fluid. Improvements in catheter design may expand the use of peritoneal dialysis as a successful home dialysis therapy.

Chronic Peritoneal Dialysis Catheters in Children: A Fifteen-year Experience of the Italian Registry of Pediatric Chronic Peritoneal Dialysis

To analyze data on 503 chronic peritoneal dialysis (CPD) catheters implanted between 1986 and 2000 in pediatric patients enrolled in the Italian Registry of Pediatric Chronic Peritoneal Dialysis (the Registry), comparing three different time periods: 1986-1990, 1991-1995, and 1996-2000. Retrospective study. 23 dialysis centers participating in the Registry. Data were collected from questionnaires filled in every year. The information for each peritoneal catheter included type, site and technique of insertion, exit-site orientation, exit-site care, complications, survival, and reason for removal. 503 catheters were implanted in 363 pediatric patients aged younger than 15 years at the start of CPD: 97 catheters in patients under 2 years of age, 67 in patients aged 2-5 years, and 339 in patients over 5 years of age. Mean patient age at onset of CPD was 8.0 +/- 5.1 years. All catheters were surgically implanted and omentectomy was performed in 82.4% of cases. The catheters used were Tenckhoff [468 (93.0%): 443 double cuff, 25 single cuff] and double-cuffed Valli [35 (7.0%)]. The entry site was in the midline in 153 cases (30.4%) and paramedian in 350 (69.6%). During 9048 dialysis-months we observed 451 catheter-related complications, yielding an incidence of 1 episode/20.1 CPD-months: 330 catheter infections (exit-site and/or tunnel infections), 26 leakages, 26 dislocations, 24 obstructions, 22 cuff extrusions, 6 hemoperitoneums, 17 others. 171 catheters were removed due to catheter-related causes; exit-site and/or tunnel infections were the main cause for removal (75.4%), followed by obstruction, dislocation, outer-cuff extrusion, and leakage. Younger children (< 2 years) had a higher risk of infectious causes of catheter removal compared to children aged 2-5 years (p = 0.004) and over 5 years of age (p = 0.002). During the 15-year observation period, a significant reduction in the incidence of leakage was observed and risk of leakage was lower in catheters with paramedian entry site compared to catheters with midline entry site. Removal and replacement of peritoneal catheters during the same surgical operation was performed in 76.3% of catheter removals. Catheter survival rate was 78.1% at 12 months, 58.5% at 24 months, 43.8% at 36 months, and 34.6% at 48 months. No difference in catheter survival was observed in younger children (< 2 years) compared with the two other age groups: < 2 years versus 2-5 years hazard ratio 0.7, 95% confidence interval (95%CI) 0.4-1.2; < 2 years versus > 5 years hazard ratio 0.8, 95%CI 0.5-1.1. In this survey, we observed better catheter survival in comparison with data reported by the Registry in 1998. Catheter survival improved especially in younger children (< 2 years), a group that previously had a decreased catheter survival rate compared to older age groups. In addition to the progressive increase in experience acquired by dialysis centers, this upward trend may also be related to greater use of double-cuffed catheters, with paramedian exit site, and a higher frequency of omentectomy.

Chronic peritoneal dialysis catheters: overview of design, placement, and removal procedures.

The success of chronic peritoneal dialysis (PD) depends to a large extent on the success of the chronic PD access device. For the nephrologist placing and removing PD catheters, or for the nephrologist advising surgeons in this role, this article provides a review of designs of PD catheters and differences in function and complications, methods of insertion of PD catheters and relation to catheter outcomes, techniques for "burying" the external portion of the PD catheter and benefits of this technique, and techniques for removing PD catheters. As nephrologists become more closely involved in the creation, monitoring, and maintenance of access devices for end-stage renal disease (ESRD) patients, the successful function of these devices will increase. Nephrologists should make the critical decisions regarding the choice of access devices and methods for placement as they do for the choice to remove such access devices.

Chronic peritoneal dialysis catheters: procedures for placement, maintenance, and removal.

Peritoneal dialysis (PD) is an integral part of the practice of most nephrologists, and a life-sustaining therapy for many of our patients. As in hemodialysis, the success of PD is often determined by the success of the access device. For the nephrologist placing and removing PD catheters, or for the nephrologist advising surgeons in this role, this article provides a review of the types of PD catheters and differences in function and complications, methods of insertion of PD catheters and relation to catheter outcomes, techniques for burying the external portion of the PD catheter and benefits of this technique, and techniques for removing PD catheters.

The Italian Registry of Pediatric Chronic Peritoneal Dialysis: A Ten-Year Experience with Chronic Peritoneal Dialysis Catheters

To analyze the data from 347 peritoneal catheters implanted in 249 pediatric patients aged < or = 15 years at start of chronic peritoneal dialysis (CPD). Restrospective study of the data collected between 1986 and 1995, in 20 dialysis centers, from the Italian Registry of Pediatric Chronic Peritoneal Dialysis. Data collection for each pediatric catheter included: catheter type, site and technique of insertion, complications, duration, and reason for removal or replacement. Fifty catheters were inserted in patients under 2 years of age, 50 in patients aged 2 - 5 years and 247 in patients over 5 years of age. Catheter types included 307 (88.5%) Tenckhoff (286 double cuff, 21 single cuff) and 40 (11.5%), double-cuff, Valli-type catheters. All catheters were surgically implanted and omentectomy was performed in 83.5% of cases; the entry-site was in the midline in 136 cases (39.2%) and paramedian in 211 (60.8%). During 6076 CPD months we observed 274 catheter-related complications: 182 catheter infections (exit-site and/or tunnel infection), 23 leakages, 19 obstructions, 19 cuff-extrusions, 14 dislocations, 6 hemoperitoneum, 10 other (incidence of one complication every 21.8 dialysis-months). A significant reduction of catheter-related complications occurred in the last five years, compared with the first 5 years. One hundred and six catheters were removed due to catheter-related causes: infection (83 cases), obstruction (11), dislocation (4), outer-cuff extrusion (3), leakage (2), bowel incarceration (2), and bowel infarction (1). Catheter survival was 72.2% at 12 months, 52.3% at 24 months, 32.8% at 36 months, and 25.7% at 48 months. Significantly lower catheter survival was found in younger children (0 - 2 years) compared with two other age groups (2 - 5 years, and > 5 years). No significant correlation was found between catheter survival and catheter entry-site (midline vs paramedian). Catheter-related infections were confirmed to be the most common complication and most frequent cause of peritoneal catheter removal. In addition, catheter survival rate was worse in younger children, indicating that more effort should be made to improve peritoneal catheter survival particularly in this age group.

Peritonitis, functional catheter loss and the sitting of the Dacron cuff in chronic peritoneal dialysis catheters in children.

Functional peritoneal dialysis catheter loss due to persistent or recurrent peritonitis is a common clinical problem in paediatric patients. To examine the effect of positioning of the cuff on infection and loss rate we compared catheters where the cuff was buried in the rectus sheath (deep cuffs) with those where the cuff was sutured to the external oblique muscle, just below the subcutaneous fascia (superficial cuffs). Of 62 catheters inserted into 35 patients (median age 7.76 yrs, range 0-17 yrs) 28 were lost through peritonitis of which 19 (68%) were due to Staph. aureus infection, usually associated with exit site colonisation or infection. 12 out of 20 catheters with superficial cuffs were lost through infection compared with 16 out of 42 with deep cuffs (relative risk reduction 37%, p = ns). Controlling for patient age and infecting organism made no difference to this statistic. 15 out of 21 catheters inserted into patients < 2yrs of age were lost through peritonitis compared to 13 out of 41 catheters inserted into patients over 2 yrs of age (p = 0.037). We conclude that although siting of the Dacron cuff in the rectus sheath is somewhat protective against penetrating infection this is still a major problem in the infant and young child where alternative strategies for the prevention of Staph. aureus infection need to be sought.

Long-term intraperitoneal deferoxamine for hemochromatosis

Intraperitoneal deferoxamine is a well established treatment for aluminum accumulation syndrome in patients with end-stage renal disease receiving peritoneal dialysis, but the use of intraperitoneal deferoxamine has not been described outside of the setting of chronic renal failure. We present here a case of secondary hemochromatosis, complicated by cirrhosis and cardiomyopathy, in which a chronic peritoneal dialysis catheter was used both to treat ascites and to deliver parenteral deferoxamine for iron overload. Daily urinary iron excretion was similar to that achieved when using standard routes of deferoxamine administration. Over a 2-year period, reversal of both the biochemical indicators and the clinical manifestations of iron overload was accomplished.

Delayed bowel erosion due to functioning chronic ambulatory peritoneal dialysis catheter

Delayed bowel erosion due to functioning chronic ambulatory peritoneal dialysis catheter