Subcutaneously implanted catheters reduce the incidence of peritonitis during CAPD by eliminating infection by periluminal route.

UNLABELLED

Recent experiences with Y-connectors suggest that the flush-before-fill effectively reduces intraluminal infection. Periluminal infection, however, remains an important route of peritonitis (P). We have recently reported reduced P incidence with the introduction of a new access technique as described by Moncrief in which the external segment of peritoneal catheter is left implanted subcutaneously for 6 weeks before exteriorization and bag exchanges. P developed once every 14.0 patient-mos with the new access while the incidence was one episode per 10.7 mos with conventional access. Significantly fewer patients with the new access compared to those with conventional access experienced P during the observation period (p < 0.01). Although the overall incidence of exit-site infection (ESI) was not different, there were significantly fewer episodes of simultaneous P and ESI with the new access (2P in 47 episodes of ESI) than with conventional access (36P in 126 ESI). While 10 of the 36 episodes of simultaneous infection in the conventional technique were caused by same organisms, none of the 2 episodes with the new access technique was caused by same organisms.

CONCLUSION

The results of this study suggest that the new access technique reduces P incidence by virtually eliminating infection by the periluminal route.