CHRONIC TUNNEL INFECTIONS IN CHILDREN - REMOVAL AND REPLACEMENT OF THE CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS CATHETER IN A SINGLE OPERATION

Objective: Chronic tunnel infections often necessitate the removal of the continuous ambulatory peritoneal dialysis (CAPD) catheter. Most published studies advocate postponing the insertion of a new catheter for several weeks. For young children it will be particularly difficult to wait this length of time, since vascular access may be cumbersome, and hemodialysis may not be well tolerated. The present study describes the results of the simultaneous removal and replacement of the CAPD catheter. Design: Twenty-three Toronto Western Hospital 11 catheters were inserted in 17 children because of infectious complications (21 chronic tunnel infections; 2 recurrent peritonitis) in a single operation under appropriate antibiotic prophylaxis. The new catheter was inserted at the contralateral side of the abdomen with the deep cuff in the midline, using the same entrance to the peritoneal cavity. Dialysis was resumed immediately after the operation. Setting: A university pediatric dialysis unit. Patients: Seventeen children (mean age 3.7 years; range 1.0-8.5 years) were studied. In this group 23 catheters were replaced. Results: In four cases are lapse of the tunnel infection was observed within 3 months. All other cases remained free of infection for a period of at least 6 months. The main causative microorganism was Staphylococcus aureus (15 occurrences). Conclusion: It is not necessary to interrupt peritoneal dialysis for the replacement of a CAPD catheter because of infectious complications.