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Chest wall peritoneal dialysis catheter placement in infants with a colostomy
V Chadha1, L L Jones, Z D Ramirez
1Section of Pediatric Nephrology, Children's Mercy Hospital, University of Missouri, Kansas City, USA.
Insights
Infants with end-stage renal disease and a colostomy can safely undergo peritoneal dialysis (PD) using a modified Swan neck catheter. This approach reduces infection risks associated with PD in this vulnerable population.
Area of Science:
- Pediatric Nephrology
- Surgical Innovation
- Infectious Disease Prevention
Background:
- Infants with end-stage renal disease (ESRD) requiring peritoneal dialysis (PD) often have a colostomy, increasing infection risk.
- Traditional PD catheter placement methods present challenges in infants with colostomies, including infection and technical difficulties.
- Existing specialized catheters have implantation and disconnection risks due to infant growth.
Observation:
- A novel approach using a larger, conventional Swan neck catheter with a chest wall exit site was adopted for two infants with ESRD and colostomy.
- PD catheters were placed in infants at 4 days and 12 days of age.
- The combined follow-up period was 50 months.
Findings:
- This modified PD catheter placement resulted in only one episode of peritonitis.
- No exit-site or tunnel infections were observed during the follow-up period.
- The approach demonstrated a low incidence of PD catheter-associated infections.
Implications:
- This technique offers a viable and safer alternative for PD catheter placement in infants with ESRD and a colostomy.
- The findings support the broader adoption of this modified approach to minimize infectious complications.
- Further studies are warranted to confirm the long-term efficacy and safety in a larger cohort.
Abstract:
The presence of a colostomy in infants with end-stage renal disease (ESRD) receiving peritoneal dialysis (PD) is associated with an inherent risk for contamination and the development of a PD catheter-associated infection. A two-piece presternal catheter designed to reduce the incidence of such infections has been used in a small number of children, but the implantation of the catheter is technically difficult, and there is a risk of disconnection of the two parts secondary to rapid patient growth in the first year of life. Alternatively, a conventional Swan neck catheter, larger than typically required, can be placed with its exit site located on the chest wall. Over the past three years, we adopted this novel approach in two patients with ESRD and a colostomy in whom PD catheters were placed at ages 4 days and 12 days, respectively. During a combined follow-up of 50 months, only one episode of peritonitis and no episodes of exit-site or tunnel infection have been observed. This experience supports the use of this unique approach to PD catheter placement in infants with ESRD and a colostomy.