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 pu blished studies advocate postponing the insertion of a new catheter fo r 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 describe s the results of the simultaneous removal and replacement of the CAPD catheter. Design: Twenty-three Toronto Western Hospital 11 catheters w ere inserted in 17 children because of infectious complications (21 ch ronic tunnel infections; 2 recurrent peritonitis) in a single operatio n under appropriate antibiotic prophylaxis. The new catheter was inser ted at the contralateral side of the abdomen with the deep cuff in the midline, using the same entrance to the peritoneal cavity. Dialysis w as resumed immediately after the operation. Setting: A university pedi atric dialysis unit. Patients: Seventeen children (mean age 3.7 years; range 1.0-8.5 years) were studied. In this group 23 catheters were re placed. Results: In four cases are lapse of the tunnel infection was o bserved within 3 months. All other cases remained free of infection fo r a period of at least 6 months. The main causative microorganism was Staphylococcus aureus (15 occurrences). Conclusion: It is not necessar y to interrupt peritoneal dialysis for the replacement of a CAPD cathe ter because of infectious complications.