Mini-invasive surgical techniques for rescuing the peritoneal catheter in refractory tunnel infections

Antonio Scalamogna, Luca Nardelli, Francesco Cosa, Silvia Pisati, Piergiorgio Messa

Research output: Contribution to journalReview articlepeer-review

Abstract

Infections continue to be a major cause of morbidity and mortality in patients on renal replacement therapy with peritoneal dialysis (PD). Despite great efforts in the prevention and treatment of infective complications over the two past decades, catheter-related infections represent the most relevant cause of technical failure. Recent studies support the idea that exit-site/tunnel infections (ESI/TI) have a direct role in causing peritonitis. Since the episodes of peritonitis secondary to TI lead to catheter loss in up to 86% of cases, it is advised to remove the catheter when the ESI/TI does not respond to medical therapy. This approach necessarily entails the interruption of PD and, after the placement of a central venous catheter, the shift to haemodialysis (HD). In order to avoid the change of dialytic method, the simultaneous removal and replacement (SCR) of the PD catheter has also been proposed. Although SCR avoids temporary HD, it requires the removal/reinsertion of the catheter and the immediate initiation of PD, with the risk of mechanical complications such as leakage and malfunction. Several mini-invasive surgical techniques have been employed as rescue procedures: curettage, cuff-shaving, the partial reimplantation of the catheter and the removal of the superficial cuff with the creation of a new exit-site. These procedures allow to save the catheter and have a success rate of 70-100%. Therefore, in case of ESI/TI refractory to antibiotic therapy, a mini-invasive surgical revision must always be considered before removing the catheter.

Original languageEnglish
Article number2021
JournalGiornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia
Volume38
Issue number1
Publication statusPublished - Feb 16 2021

Keywords

  • cuff-shaving
  • exit-site infection
  • peritoneal dialysis
  • peritonitis
  • tunnel infection
  • ultrasounds

ASJC Scopus subject areas

  • Medicine(all)

Fingerprint

Dive into the research topics of 'Mini-invasive surgical techniques for rescuing the peritoneal catheter in refractory tunnel infections'. Together they form a unique fingerprint.

Cite this