Dialysis Catheter Exit Site Research Articles

Interobserver agreement of peritoneal dialysis exit site scoring: Results from the Standardizing Care to Improve Outcomes in Pediatric End Stage Kidney Disease (SCOPE) collaborative.

Exit site infections are a risk factor for the development of peritonitis in patients on long-term peritoneal dialysis. Visual assessments of an exit site utilising currently available tools (Twardowski and Mid-European Pediatric Peritoneal Dialysis Study Group (MEPPS)) are necessary to objectively characterise the appearance of an exit site. The aim of this study was to assess the interobserver agreement of exit site evaluations utilising both exit site scoring tools. Exit site evaluations were independently performed by two evaluators during outpatient visits at 13 sites within the Standardizing Care to Improve Outcomes in Pediatric End Stage Kidney Disease collaborative. The frequency and percentage of evaluations where both reviewers agreed were calculated. A sub-analysis was performed looking at evaluations where disagreement occurred. A total of 371 paired exit site evaluations were collected over 6 months. For the majority of evaluations (range: 78%-97% Twardowski, 78%-97% MEPPS), both reviewers agreed that no abnormality was present across all domains. When the analysis was restricted to evaluations where at least one reviewer noted an abnormality, interobserver agreement fell across all domains (range: 31%-61% Twardowski, 56%-66% MEPPS). Disagreements more commonly occurred regarding the presence versus absence of an abnormality, rather than a difference in the severity of an abnormality. Whereas interobserver agreement is high when the appearance of a peritoneal dialysis catheter exit site is characterised as 'normal', interobserver disagreement is common when the appearance of the exit site is 'abnormal'. Further work is warranted to improve interobserver agreement of exit site assessments and to identify domains conferring an increased risk of infection.

Tunnel ultrasound can guide the use of peritoneal dialysis catheter exit site relocation by external splicing and cuff removal in refractory tunnel infection

BackgroundPeritoneal dialysis (PD) catheter related infections continue to be a major cause of morbidity and transfer to hemodialysis (HD) in PD patients. The treatment of tunnel infection (TI) could be challenging, especially when the infection involves the superficial cuff requiring the removal of the catheter. To spare the patient the loss of the catheter and the transfer to HD, several mini-invasive surgical techniques have been proposed as rescue therapy. Furthermore, nowadays, the rapid growth of digital technology has enormously increased the diagnostic sensibility of the echo signal allowing to accurately defines the extent of the infectious process along the PD catheter tunnel.MethodsBetween 1st January 2020 and 31st December 2021 seven patients who underwent exit-site relocation by external splicing and cuff removal at our institution due to refractory TI were included in the study. All patients were followed until 12 months after the procedure. As soon as TI was defined refractory to the medical therapy, an ultrasonographic examination of the catheter tunnel was performed to define the extent of the infectious episode.ResultsAmong the 7 infectious episodes, 4 were caused by P. aeruginosa, and 3 by S. aureus. Around the superficial cuff the hypo/anechoic collections detected by ultrasounds showed a mean diameter of 3.05 ± 0.79 mm. The exit-site relocation by external splicing and cuff removal was successful in all cases (7/7, 100%).ConclusionsIn our experience the use of exit site relocation by external splicing and cuff removal as rescue therapy for TI with positive ultrasounds for TI limited to superficial cuff involvement and without secondary peritonitis, yielded to promising results with a success rate of 100%. This preliminary experience underlines the paramount usefulness of tunnel echography in accurately defining the extent of TI and, consequently, guiding the choice of the therapeutical approach in refractory TI.

"External Iliac Vein Laceration-A Rare Complication of Tunneled Dialysis Catheter"

Bleeding complication from Central dialysis catheter is rare. Usually it settles in short time after procedure. If patient is on antiplatelet therapy it can sometimes last for 24-48 hours and stops with pressure dressing. We report a rare case of ongoing (>96 hour post procedure) bleeding from dialysis catheter exit site and investigation revealed the cause was iliac vein laceration.

Application of a Physical Antimicrobial Spray Dressing for Reducing Postoperative Peritoneal Dialysis Catheter Exit Site Infection in End-stage Renal Failure Patients: A Prospective Cohort Study

Application of a Physical Antimicrobial Spray Dressing for Reducing Postoperative Peritoneal Dialysis Catheter Exit Site Infection in End-stage Renal Failure Patients: A Prospective Cohort Study

Dermabacter hominis: a usually daptomycin-resistant gram-positive organism infrequently isolated from human clinical samples.

During a 12-year period, Dermabacter hominis was isolated from 21 clinical samples belonging to 14 patients attending a tertiary hospital in León, Spain. Samples included blood cultures (14), peritoneal dialysis catheter exit sites (three), cutaneous abscesses (two), an infected vascular catheter (one) and a wound swab (one). Identification was made by API Coryne™ V2.0, Biolog™ GP2 and 16S rRNA gene amplification. Six febrile patients had positive blood cultures (one, two or three sets) and all of them were treated with teicoplanin (two patients), vancomycin, ampicillin plus gentamicin, amoxicillin/clavulanic acid and ciprofloxacin (one each). An additional patient with a single positive blood culture was not treated, the finding being considered non-significant. In the remaining seven patients the organism was isolated from a single specimen and three of them received antimicrobial treatment (ciprofloxacin, ceftriaxone plus vancomycin and amoxicillin/clavulanic acid). At least ten patients had several underlying diseases and conditions, and no direct mortality was observed in relation to the isolated organism. All isolates were susceptible to vancomycin, rifampin and linezolid. Resistance to other antibiotics varied: erythromycin (100%), clindamycin (78.5%), ciprofloxacin (21.4%) and gentamicin, quinupristin-dalfopristin, benzylpenicillin and imipenem 7.1% each. Thirteen isolates were highly resistant to daptomycin with MICs ranging from 8 to 48 (MIC90 = 32 mg/L); only one was daptomycin-sensitive (MIC = 0.19 mg/L).

Effectiveness of different types of care for the peritoneal dialysis catheter exit site: a systematic review

Background Prevention of infection is considered essential for satisfactory maintenance of peritoneal dialysis. Infections of the peritoneal dialysis catheter tunnel and exit site are considered to be serious infections that may predispose patients to peritonitis and its consequences. Objective To evaluate and summarise the best available evidence on the effectiveness of care for the peritoneal dialysis catheter exit site. Inclusion criteria Types of participants Adult and paediatric patients receiving peritoneal dialysis Types of Interventions Antiseptics, topical antimicrobials agents, dressings and educational interventions Type of studies Randomised controlled trials Types of Outcomes Incidence of tunnel and exit site infection and peritonitis, caused by Staphylococcus aureus, Pseudomona aeruginosa, Haemophilus, Neisseria, Escherichia coli, etc. Search strategy All studies, published (in MEDLINE, CINAHL and COCHRANE databases) and unpublished, in English, Spanish, Portuguese and French, carried out between 1996 and February 2009 were retrieved. ,. Methodological quality The methodological quality of included articles was assessed by two independent reviewers using critical appraisal tools from the Joanna Briggs Institute. Data extraction Data were independently extracted by two reviewers, using the standardised data extraction tool from the Joanna Briggs Institute. Data synthesis Results were combined in meta-analysis where appropriate. Results Nine randomized controlled trials were included. In one study that compared the effectiveness of daily application of gentamicin cream with mupirocin, in the gentamicin group there were a total of 15 infections of the exit site compared to the mupirocin group where there were 29 infections (OR= 2.72; 95% CI 1.28-5.77); there were 22 incidences of peritonitis in the gentamicin group, compared to 28 incidences of peritonitis in the mupirocin group ( OR= 1.51; 95% CI 0.74-3.05). In three studies, patients received povidone-iodine and the control group received standard care. The overall results of the meta-analysis estimated an OR=0.83 with 95% CI 0.47–1.45 for the prevention of infection of the exit site and an OR=0.77 with 95% CI 0.44–1.36 for prevention of peritonitis. One study compared the effectiveness of chlorhexidine versus liquid soap, showing that there was a statistically significant lower exit-site infection rate in the group of patients that used chlorhexidine soap compared with the group that used pure liquid soap.(OR 0.35 with 95% CI 0.13-0.94). Another study compared povidone-iodine vs. chlorhexidine vs. sodium hypochlorite, and found no statistically differences between povidone and chlorhexidine and found no differences between the use of povidone and sodium hypochlorite. Another three studies compared mupirocina vs. standard care; mupirocina vs. fusidic acid; and fusidic acid vs. ofloxacin, and found no differences in reducing exit site infections or peritonitis. Conclusions Some interventions appear to be more effective than others in terms of peritoneal dialysis catheter exit site care. These advantages are related to a lower number of cases of exit site infection and, consequently, peritonitis. The application of an antiseptic to the peritoneal dialysis catheter exit site reduces infections and prevents the peritonitis that is a consequence of exit site infection; however, the results do not demonstrate the superiority of any one of povidone, chlorhexidine, hypochlorite or washing with soap.

Quiz Page September 2012: Erythematous Rash Around Peritoneal Dialysis Catheter Exit Site

Quiz Page September 2012: Erythematous Rash Around Peritoneal Dialysis Catheter Exit Site

Do topical antibiotics reduce exit site infection rates and peritonitis episodes in peritoneal dialysis patients? The Pan Thames Renal Audit

Peritonitis is the major cause of peritoneal dialysis (PD) technique failure. Prophylactic topical antibiotics have been reported to reduce peritoneal dialysis catheter exit site infections (ESI) and peritonitis rates. We audited the effect of different exit site practices in the 12 Pan Thames and South East England PD centres, on ESIs and peritonitis between 2005 and 2008. PD patients used prophylactic mupirocin (n=1,270), gentamicin (n=502) and no prophylactic antibiotics (n=1,203); annualised ESI rates were reduced with mupirocin (median 0.18, interquartile range [IQR] 0.13-0.23, patient episodes per year, vs. median 0.32, IQR 0.24-0.69, for no antibiotic prophylaxis, p<0.01). Gentamicin treatment was not significantly lower (median 0.29, IQR 0.21-0.47). Staphylococcal ESIs accounted for 39.6% in the no antibiotic group and fell to 25.7% with mupirocin and 28.2% with gentamicin. Despite the reduction in ESIs, there was no significant reduction in peritonitis rates (no antibiotics: median 0.56, IQR 0.5-0.65; mupirocin: median 0.55, IQR 0.53-0.75; and gentamicin: median 0.47, IQR 0.32-0.65). In particular, mupirocin did not reduce Staphylococcus aureus peritonitis rates. Topical antibiotics have been reported to reduce both ESI and peritonitis rates in controlled trials, and although in this audit of routine clinical practice, topical mupirocin did reduce overall ESI rates and both mupirocin and gentamicin reduced S. aureus ESIs, neither reduced overall peritonitis rates.

Nontuberculous mycobacterial exit-site infection and abscess in a peritoneal dialysis patient

Nontuberculous mycobacterial infections of peritoneal dialysis catheter exit sites have rarely been reported in patients on peritoneal dialysis. We report here a case of Mycobacterium abscessus exit site infection with abdominal wall abscess formation in an adolescent on peritoneal dialysis, which required long-term antibiotic therapy, peritoneal dialysis catheter removal, and surgical debridement of the abscess. Nontuberculous mycobacteria should be considered as a possible causative organism for an exit site infection that fails to respond to usual antibiotic therapy. Nontuberculous mycobacterial exit site infections may require peritoneal dialysis catheter removal and surgical debridement.

A Prospective, Randomized Trial Comparing a Transparent Dressing and a Dry Gauze on the Exit Site of Long Term Central Venous Catheters of Hemodialysis Patients

The objective of this study was to assess the risk of bacteremia, estimate the cost and evaluate the quality of life by using a transparent dressing (TD) versus (vs) a dry gauze (DG) on the exit site of long term central I.V. catheters (LTCC) of hemodialysis patients. This 6-months preliminary study was conducted on 58 patients (pts) randomized to receive DG replaced 3 times/week (29 pts) or TD replaced every 7 days (29 pts). Data on patients, conditions of the exit site, local infection, bacteremia, quality of life and cost related to each type of dressing were collected. Two pts in the DG group experienced bacteremia related to their LTCC vs 1 pt in the group TD. A total of 7 (DG) vs 13 (TD) pts experienced skin condition changes at the catheter exit site. Some skin reactions, erythema and pruritus, did occur initially in the group TD and was due in part to insufficient drying time of the skin preparation solution. The estimated individual, weekly costs for using the DG was $7.60 vs $4.72 Canadian dollars for the TD. The SF-36trade mark scores did not show a significant difference between the 2 groups during the study (3.8 (PCS), 6.4 (MCS) at study end). Although this study was statistically underpowered, it suggests that the incidence of bacteremia was not increased with the use of a TD. Moreover, the use of a TD allowed fewer dressing changes, lowered total treatment costs, with no observed unfavorable impact on the quality of life and without significant local complications of the exit site. Based on the positive results observed in this pilot study, further study is warranted to examine the cost effectiveness of long-term use of TD dressings on dialysis catheter exit sites.

OERSKOVIA XANTHINEOLYTICA PERITONITIS: CASE REPORT AND REVIEW

OERSKOVIA XANTHINEOLYTICA PERITONITIS: CASE REPORT AND REVIEW

Peritoneal Dialysis Catheter Exit Site Infections: Prevention, Diagnosis, Treatment, and Future Directions

Peritoneal Dialysis Catheter Exit Site Infections: Prevention, Diagnosis, Treatment, and Future Directions