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Published on: June 14, 2015
Fibrin glue used successfully in peritoneal dialysis catheter leakage in children
Esther Rusthoven1, Nicole A C J van de Kar, Leo A H Monnens
1Department of Pediatric Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands. erusthoven@hotmail.com
Insights
Fibrin glue effectively treats peritoneal dialysis catheter leakage in children with acute renal failure. This simple, safe method prevents further leakage and complications, avoiding surgery.
Area of Science:
- Pediatric Nephrology
- Surgical Innovation
Background:
- Acute renal failure in children often requires peritoneal dialysis (PD).
- Early dialysate leakage post-catheter implantation can compromise PD effectiveness.
- Fibrin glue offers a potential non-surgical solution for PD catheter leakage.
Purpose of the Study:
- To evaluate the efficacy and safety of fibrin glue in managing PD catheter leakage in pediatric patients.
- To determine if fibrin glue application can prevent the need for surgical intervention.
Main Methods:
- Fibrin glue was applied to the external tunnel of PD catheters in 8 children experiencing leakage within 48 hours of insertion.
- The study monitored for recurrent dialysate leakage and complications like infections.
Main Results:
- Fibrin glue successfully resolved dialysate leakage in all 8 patients, with no relapses observed.
- No exit-site infections, tunnel infections, or peritonitis occurred during PD treatment.
Conclusions:
- Fibrin glue is a successful, simple, and safe treatment for peritoneal dialysate leakage in pediatric patients undergoing PD.
- This method effectively manages leakage and prevents complications, supporting PD therapy in infants and small children.
Background:
Acute renal failure in infants and small children is generally treated with peritoneal dialysis (PD). Dialysis has to be started immediately after catheter implantation. Early dialysate leakage can complicate the effectiveness of dialysis. Fibrin glue applied to the external part of the tunnel may stop dialysate leakage and eliminate the need for surgical intervention. The use of fibrin glue in the treatment of PD catheter leakage in children was studied.
Methods:
Fibrin glue was used in 8 children (age 0.8 - 57 months) on PD in whom dialysate leakage was seen during the first 24 to 48 hours after catheter insertion. The dialysis volume initially administered was 20 mL/kg body weight. Fibrin glue (1 mL) was applied to the external part of the subcutaneous catheter tunnel through the exit site, as close to the cuff as possible. The occurrence of dialysate leakage and complications such as exit-site or tunnel infection and peritonitis were evaluated.
Results:
Nine single-cuff straight Tenckhoff catheters were implanted in 8 children. In 5 cases, no subcutaneous tunnel was created. One child had catheter replacement due to obstruction of the catheter; on both occasions, catheter leakage was seen and treated with fibrin glue. In all 8 patients, no relapse of dialysate leakage was seen after application of the fibrin glue. During the time of PD, exit-site infections, tunnel infections, and peritonitis did not occur.
Conclusion:
Fibrin glue is a successful, simple, and safe substance for the treatment of peritoneal dialysate leakage in infants and small children with acute renal failure treated with PD.
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