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One-step peritoneal catheter replacement in children
I Goldraich1, M Mariano, N Rosito
1Department of Pediatrics, Hospital de Clínicas de Porto Alegre, Brazil.
Insights
Replacing peritoneal dialysis catheters in children can now be done without stopping treatment. This one-step surgical method avoids complications from temporary hemodialysis, ensuring continuous care for pediatric patients.
Area of Science:
- Pediatric Nephrology
- Surgical Innovation
Background:
- Catheter replacement in pediatric peritoneal dialysis (PD) often requires treatment interruption.
- Discontinuation of PD poses challenges with vascular access and hemodialysis in children.
Purpose of the Study:
- To evaluate the safety and efficacy of a one-step, uninterrupted catheter replacement procedure in pediatric patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
Main Methods:
- A 5-year retrospective study involving 9 pediatric patients (4 infants, 2 preschool, 3 school-age) requiring 15 peritoneal access device replacements.
- All procedures were performed surgically under general anesthesia as a one-step removal and replacement.
- Postoperative management included prophylactic antibiotics and adjusted fluid exchange volumes to maintain low intra-abdominal pressure.
Main Results:
- No patient required interruption of CAPD or interval hemodialysis.
- Successful catheter replacement was achieved in all cases, with only one episode of tunnel infection relapse within 2 months.
- No recurrence of peritonitis was observed during the follow-up period.
Conclusions:
- One-step peritoneal catheter replacement is a safe and effective strategy for pediatric patients on CAPD.
- This technique avoids treatment disruption, preventing the need for hemodialysis and maintaining continuous PD therapy.
Abstract:
The interruption of chronic peritoneal dialysis for a period of time is recommended for replacement of the peritoneal catheter due to tunnel infection and/or relapsing peritonitis. In pediatric patients, in the younger ones, in particular, discontinuation of peritoneal dialysis can be problematic--there are difficulties associated with vascular access and hemodialysis. Over a 5-year period 9 children (4 infants, 2 preschool, 3 school-age) required 15 peritoneal access device replacements, without interruption of continuous ambulatory peritoneal dialysis (CAPD). The reasons for catheter replacement were tunnel complications (10), relapsing bacterial peritonitis (3), and fungal peritonitis (2). All catheter removals and placements were performed by surgical method under general anesthesia in a one-step procedure. The new catheters were implanted on the opposite side of the abdominal wall in all except one child, who had a colostomy. All patients received prophylactic antibiotics in the bags. In the postoperative period the patients infused smaller exchange volumes during 2 weeks. In the older children the exchange volumes were increased overnight. This schedule resulted in low intra-abdominal pressure. No patient required interval hemodialysis. Relapse of tunnel infection occurred in one episode in the first 2 months. We did not observe, in the same period, recurrence of peritonitis. One-step catheter replacement has been demonstrated to be safe; it avoids the disruption of ongoing treatment and promotes patient maintenance on CAPD.