Reduction in Peritonitis Incidence in Continuous Ambulatory Peritoneal Dialysis with a New Catheter and Implantation Technique

Recurrent episodes of peritonitis with the same organism cultured at the catheter exit site suggest that early tunnel colonization is associated with a transfer of these organisms through the catheter tunnel directly from the skin Into the peritoneal cavity. In this instance the catheter has failed In Its fundamentel design to establish and maintain a bacteriological berrier. A three-part study was conducted using the Moncrlef-Popovich catheter and Implantation technique. The first part of the study Included 59 patients who used standard spike exchange systems with this new catheter and implantation technique. A reduction in the incidence of peritonitis occurred in the continuous ambulatory peritoneal dialysis (CAPO) program at the Austin Olagnostic Clinic. The previous peritonitis incidence was 1 every 9 patient-months. This study had 1 every 29 patient-months with 530 patient months of experience. The second part of the study had 79 patients. All except 11 used disconnect exchange systems. There was a total of 482 patient-months of experience with 1 episode every 27 patient-months. Those using the disconnect systems (86%) had 1 episode every 32 petient-months. The third part of the study Included microscopic studies of 12 excised catheters. Three were known to be contaminated. The examiners identified those catheters that were free or nearly free of biofilm on the catheter segment between the two cuffs. It Is concluded that biofilm analysis and reduction In peritonitis Incidence supports the theory that the new catheter and implantation technique form an Improved becterlologlcal barrier In the access for peritoneal dialysis.

Peritoneal Catheter Survival in Children

In children undergoing CAPD or CCPD, the authors compared two techniques for peritoneal catheter insertion by analyzing the probabilities for overall catheter survival, catheter outflow failure and peritonitis. Between January 1980 and December 1982, catheters were installed with a slightly arcuate subcutaneous tunnel with a predominantly transverse orientation. After December 1982 catheters were implanted with a straight subcutaneous tunnel directed caudally toward the pelvis. We found that a catheter directed toward the pelvis was associated with improved overall survival. Adoption of this technique greatly reduced outflow obstruction, the leading cause of catheter failure before 1983. However, the orientation of the extraperitoneal catheter segment did not appear to influence the overall risk for peritonitis.

Tenckhoff Catheter Repair by the Splicing Technique

One of the main complications of the double-cuffed chronic peritoneal dialysis catheters is cuff erosion, with or without exit-site infection. We present a simple technique, which allows partial replacement of the external catheter segment with splicing. In addition it can be used to replace the intraperitoneal segment, leaving undisturbed the external segment and exit site. This technique can be carried out under local anesthesia, as an outpatient procedure, without interrupting treatment and with less trauma than total catheter replacement. This paper describes our experience with 20 external catheter replacements in 17 patients followed up to 20 months.