Exit-Site Relocation: A Novel, Straightforward Technique for Exit-Site Infections

Area of Science:

• Nephrology
• Infectious Diseases
• Surgical Procedures

Background:

• Exit-site infection (ESI) and tunnel infection (TI) are major causes of peritoneal dialysis (PD) catheter loss and patient morbidity.
• Current treatments like catheter replacement or splicing lack universal acceptance and may necessitate temporary hemodialysis.
• Alternative methods for managing chronic ESI are needed to maintain PD therapy.

Purpose of the Study:

• To evaluate the efficacy and safety of a novel exit-site relocation technique for treating chronic ESI in PD patients.
• To determine if this procedure allows patients to remain on PD without switching to hemodialysis.

Main Methods:

• A retrospective cohort analysis of 27 PD patients with chronic ESI who underwent exit-site relocation under local anesthesia.
• The procedure involved relocating the exit site and removing the external catheter cuff.
• Peritoneal dialysis was resumed immediately post-procedure.

Main Results:

• Long-term infection resolution was achieved in 74% (20/27) of patients.
• No dialysate leaks occurred.
• Catheter removal was necessary in 26% (7/27) due to recurrent ESI or TI, with 2 cases progressing to PD peritonitis.

Conclusions:

• Exit-site relocation is a safe, simple, and effective treatment for chronic ESI in PD patients.
• This technique allows for the continuation of PD therapy, avoiding the need for hemodialysis.
• It offers a viable solution for managing chronic exit-site infections.