CAPD catheter replacement and translocation of the exit site

Persistent exit site infections and chronic tunnel infections are the main complications related to peritoneal dialysis catheter. Usually these complications are managed by antibiotic administration, unroofing and/or cuff shaving, but sometimes these therapeutic approaches are not effective. After the catheter has been used for a prolonged period, it becomes fragile and carries a risk of breaking down. Thus, we have devised a partial replacement system for peritoneal dialysis catheters thatinvolves splicing a new external segment furnished with a Dacron cuff to original catheter. We applied this approach to ten patients (eight persistent tunnel infections, two fragile catheters used for ten years). In one case, we removed the original catheter and re-implanted a new one because the original catheter broke during surgery. In all other patients, the usual peritoneal dialysis could be restarted immediately after surgery. There are some reports describing partial replacement of the peritoneal dialysis catheter for persistent exitsite infection or chronic tunnel infection, but these procedures were expensive. We conclude that our procedure is as useful as other procedures reported previously but the cost is lower.