Simultaneous catheter removal and replacement in peritoneal dialysis infections: update and current recommendations

Problematic peritoneal dialysis infection is a major cause of catheter loss and interruption of peritoneal dialysis (PD) therapy. In selected instances, problematic infection can be successfully treated by removing and replacing the catheter while continuing with PD. Accumulated experience has helped to define the circumstances under which a removal/replacement procedure is likely to be safe and under which complications are likely to arise. It appears that simultaneous removal and replacement can be expected to succeed when problematic infection is associated with tunnel infection, with recurring peritonitis repetitively culturing the same organism but clearing between episodes, and with gram-positive organisms. Success is less likely in the presence of ongoing inflammation, of active infection, of gram-negative or fungal organisms, or of any evidence of intra-abdominal adhesions. We review the literature on which these criteria are based and conclude with updated recommendations.