One-step peritoneal catheter replacement in children.

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.