Reduction in peritonitis incidence in continuous ambulatory peritoneal dialysis with a new catheter and implantation technique.

Recurrent episodes of peritonitis with the same organism cultured at the catheter exit site suggest that early tunnel colonization is associated with a transfer of these organisms through the catheter tunnel directly from the skin into the peritoneal cavity. In this instance the catheter has failed in its fundamental design to establish and maintain a bacteriological barrier. A three-part study was conducted using the Moncrief-Popovich catheter and implantation technique. The first part of the study included 59 patients who used standard spike exchange systems with this new catheter and implantation technique. A reduction in the incidence of peritonitis occurred in the continuous ambulatory peritoneal dialysis (CAPD) program at the Austin Diagnostic Clinic. The previous peritonitis incidence was 1 every 9 patient-months. This study had 1 every 29 patient-months with 530 patient-months of experience. The second part of the study had 79 patients. All except 11 used disconnect exchange systems. There was a total of 482 patient-months of experience with 1 episode every 27 patient-months. Those using the disconnect systems (86%) had 1 episode every 32 patient-months. The third part of the study included microscopic studies of 12 excised catheters. Three were known to be contaminated. The examiners identified those catheters that were free or nearly free of biofilm on the catheter segment between the two cuffs. It is concluded that biofilm analysis and reduction in peritonitis incidence supports the theory that the new catheter and implantation technique form an improved bacteriological barrier in the access for peritoneal dialysis.