Pelvic drainage during removal of dialysis catheter decreases the risk of subsequent intra-abdominal complications in refractory peritoneal dialysis-related peritonitis

Aim Some patients with refractory peritoneal dialysis‐related peritonitis continue to develop intra‐abdominal complications despite removal of the peritoneal catheter. Repeated percutaneous drainage or open laparotomy is often required, and mortality is not uncommon. The benefits of pelvic drainage...

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Bibliographic Details
Published in:Nephrology (Carlton, Vic.) Vic.), 2015-11, Vol.20 (11), p.855-861
Main Authors: Hsu, Chih-Yang, Huang, Wei-Chieh, Huang, Chun-Kai, Huang, Chien-Wei, Chou, Nan-Hua, Lee, Po-Tsang, Fang, Hua-Chang, Chou, Kang-Ju, Chen, Chien-Liang
Format: Article
Language:English
Subjects:
Adult
Anti-Bacterial Agents - therapeutic use
catheter removal
Catheter-Related Infections - diagnosis
Catheter-Related Infections - microbiology
Catheter-Related Infections - therapy
Catheters, Indwelling - adverse effects
Combined Modality Therapy
Device Removal - adverse effects
dialysis
drainage
Drainage - adverse effects
Equipment Design
Female
Humans
Male
Middle Aged
Peritoneal Dialysis - adverse effects
Peritoneal Dialysis - instrumentation
peritonitis
Peritonitis - diagnosis
Peritonitis - microbiology
Peritonitis - therapy
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
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Summary:Aim Some patients with refractory peritoneal dialysis‐related peritonitis continue to develop intra‐abdominal complications despite removal of the peritoneal catheter. Repeated percutaneous drainage or open laparotomy is often required, and mortality is not uncommon. The benefits of pelvic drainage placement during catheter removal in decreasing these complications and interventions remain unproven. Methods Forty‐six patients with refractory peritonitis who underwent removal of a Tenckhoff catheter between 1991 and 2013 were reviewed retrospectively. Twelve patients had pelvic drainage using closed active suction devices during catheter removal (drainage group). The remaining 34 patients underwent catheter removal without drainage (non‐drainage group). The outcomes measured were the development of intra‐abdominal complications and the requirement for repeated percutaneous drainage or open laparotomy within 90 days after the catheter removal. Results Baseline characteristics were similar with the exception of a higher median number of previous peritonitis episodes in the drainage group compared with the non‐drainage group (2 vs 0, P = 0.02). During the follow‐up period, intra‐abdominal complications occurred in 15 (44%) of 34 patients in the non‐drainage group, compared with one (8%) of 12 patients in the drainage group (P = 0.03). Twelve (35%) patients in the non‐drainage group required repeated percutaneous drainage or open laparotomy for management, compared with zero (0%) patients in the drainage group (P = 0.02). Drain tubes were removed at a median of 6 days (inter‐quartile range: 5–10) without complications. Conclusions In the management of refractory peritonitis, pelvic drainage during removal of dialysis catheter decreases the risk of subsequent intra‐abdominal complications and invasive interventions. Summary at a Glance The authors report the benefits of pelvic drainage at the time of PD catheter removal in refractory PD peritonitis. The purpose is interesting and the results potentially provide important insight into the appropriate management of PD patients.
ISSN:1320-5358
1440-1797
DOI:10.1111/nep.12514