Conservative surgical management of catheter infections in children on peritoneal dialysis
Related Experiment Video
Updated: Jun 22, 2026
A Retrograde Implantation Approach for Peritoneal Dialysis Catheter Placement in Mice
Published on: July 20, 2022
Francesco Macchini1, Sara Testa, Alberto Valadè
1Department of Pediatric Surgery, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, via Commenda 10, 20122, Milan, Italy. francesco.macchini@unimi.it
Insights
Shaving the external cuff and creating a new tunnel for peritoneal dialysis catheters can effectively treat chronic exit-site or tunnel infections in children, preventing recurrence.
Area of Science:
- Pediatric Nephrology
- Surgical Innovation
- Infectious Disease Management
Background:
- Chronic exit-site infection (ESI) and tunnel infection (TI) are common reasons for peritoneal dialysis catheter removal.
- Optimal treatment strategies for these infections in pediatric patients remain undefined.
Purpose of the Study:
- To evaluate the efficacy of a conservative surgical approach for treating recurrent ESI or TI in children undergoing peritoneal dialysis.
Main Methods:
- A retrospective analysis of 13 pediatric patients with recurrent ESI or TI treated over 10 years.
- Surgical intervention involved shaving the external cuff of a double-cuff straight Tenchkoff catheter.
- A new, tightly adherent tunnel was created, with the exit-site relocated to the contralateral abdomen.
Main Results:
- The study included 13 patients (7 female, mean age 56 months) with recurrent ESI (4) or TI (9).
- Staphylococcus aureus was the predominant pathogen (12 patients).
- No recurrence of ESI or TI was observed during a mean follow-up of 31 months per catheter.
Conclusions:
- Conservative surgical treatment, specifically cuff shaving and new tunnel creation, appears effective in managing recurrent peritoneal dialysis catheter infections in children.
- This approach may serve as an alternative to catheter removal, potentially improving long-term dialysis outcomes.
Introduction:
Major indications for peritoneal dialysis catheter removal include chronic exit-site infection (ESI) or tunnel infection (TI). No consensus on the optimal treatment of these infections in children exists.
Patients:
During the last 10 years, 13 patients (7 females, mean age 56 months) on peritoneal dialysis were treated for recurrent ESI (N: 4) or TI (N: 9). Staphylococcus aureus (12 patients) and Pseudomonas aeruginosa (1 patient) were isolated. All patients had a double-cuff straight Tenchkoff catheter and underwent the shaving of the external cuff, with a new tunnel tightly adherent to the catheter, and an exit-site in the opposite abdominal region. A mean follow-up of 31 months/catheter demonstrated no recurrence of ESI and TI.
Discussion:
Little pediatric experience with cuff shaving exists: reported catheter salvage rates are 48-100%. In our experience, good results were obtained by shaving off the external cuff and re-creating a new tunnel, with a different course, strictly adherent to the catheter. This measure seems to guarantee an effective barrier against infections, while obviating the need of the external cuff.
Conclusions:
Sometimes, in case of recurrent ESI or TI, the external cuff may facilitate the persistence of bacteria. A conservative surgical treatment offers good results in children.
Related Concept Videos
01:25Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications
01:25Peritoneal Dialysis III: Nursing Management
01:20Acute Kidney Injury V: Interprofessional Care
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
01:26Kidney Transplant II: Surgical Procedure
01:30Peritoneal Dialysis I: Introduction and Procedure