REPAIR OF CHRONIC PERITONEAL-DIALYSIS CATHETER

Background: Damage to the peritoneal dialysis catheter may be due to w ear from long-term use, exposure to antibacterial agents (strong oxida nts), and accidental injury from sharp objects. Repair of such cathete r, if not associated with subsequent complications, would extend cathe ter life and reduce costs and patient inconvenience related to cathete r replacement. Objective and Design: Retrospective analysis of seven p eritoneal catheters repaired 11 times over a 15-year period by splicin g the old catheter with an extension tube using the Peri-Patch Repair Kit (Quinton Instrument Co., Bothwell, WA, U.S.A.). Results:The life o f these seven catheters was extended by a mean of 26 months (range 1 - 87 months), without increasing infection rates after splicing. The pe ritonitis rate after catheter splicing was 0.40 per year, not higher t han the overall rate (0.76 per year) in our center during the same tim e period. Exit-site infections occurred in 6 patients after catheter s plicing. Only one infection was related to trauma during the procedure and resulted in chronic exit infection; the catheter was eventually r emoved. In this patient, damage to the catheter was less than 1.5 cm f rom the exit site. Conclusions and Recommendations: Splicing of the da maged peritoneal catheter, if properly done, is a safe procedure and c an significantly prolong catheter life. We recommend that measures to prevent catheter damage, such as avoiding the use of scissors and othe r sharp objects, should be emphasized during the initial patient educa tion and training. Alcohol and iodine should not be used on silicone r ubber catheters. We suggest that the patient should report catheter da mage immediately and come to the clinic within a few hours for cathete r splicing (if possible) and prophylactic antibiotic to prevent perito nitis. Finally, we recommend that repair of the catheter should not be attempted if the breakage is less than 2 cm from the exit site, unles s done as an emergency procedure if immediate catheter replacement can not be performed.