Posthuma N, Borgstein P J, Eijsbouts Q, ter Wee P M
Department of Nephrology, ICaR-VU, Academic Hospital Vrije Universiteit, Amsterdam, The Netherlands.
Nephrol Dial Transplant. 1998 Mar;13(3):700-3. doi: 10.1093/ndt/13.3.700.
Catheter-related infections result in high patient morbidity, the need for temporary haemodialysis, and high costs. These infections are the main cause of limited technique survival in peritoneal dialysis. We introduced a protocol for the simultaneous peritoneoscopic insertion and removal of peritoneal catheters in patients with catheter-related infections. Peritoneal dialysis was continued the day after surgery using low-volume dwells and a dry abdomen during the daytime. The dialysate leukocyte count had to be below 100/mm3 before exchanging catheters, which was performed under antibiotic therapy based on culture sensitivity. The old catheter was removed after the new catheter had been inserted in the opposite abdominal region. CAPD patients were switched to APD for 1 week, which made prolonged hospitalization necessary. Simultaneous catheter insertion and removal was performed 25 times in 22 patients on CCPD and 15 times in 14 patients on CAPD. In CCPD patients, peritoneal dialysis was restarted after 1.0+/-0.1 days in 24 cases. One patient had sufficient residual renal function and discontinued CCPD until day 10. In 10 CAPD patients (11 procedures) APD was started 1.3+/-0.2 days after the procedure with CAPD beginning 7.1+/-0.6 days thereafter. Three CAPD patients preferred haemodialysis and restarted CAPD 10.0+/-2.1 days after surgery. One patient continued CAPD the day after surgery. In addition to minor complications (e.g. position-dependent outflow problems), dialysate leakage occurred in two patients. Two patients developed peritonitis within the first 30 days after surgery, one of which was procedure related. One patient had severe lower gastrointestinal bleeding 2 weeks after the procedure, which was not related to the catheter replacement. Ultimately, in 38 of 40 procedures the patients could successfully continue peritoneal dialysis. We conclude that simultaneous insertion and removal of a peritoneal dialysis catheter without interruption of peritoneal dialysis is a safe procedure in patients with catheter-related infections.
导管相关感染会导致患者出现高发病率、需要进行临时血液透析以及产生高昂费用。这些感染是腹膜透析技术生存率受限的主要原因。我们引入了一项针对导管相关感染患者同时进行腹腔镜下插入和拔除腹膜导管的方案。术后次日使用小容量留腹并在白天保持腹部干燥继续进行腹膜透析。在更换导管前，透析液白细胞计数必须低于100/mm³，更换操作在基于培养敏感性的抗生素治疗下进行。在腹部对侧区域插入新导管后再拔除旧导管。持续性非卧床腹膜透析（CCPD）患者转为自动化腹膜透析（APD）1周，这使得延长住院时间成为必要。22例CCPD患者进行了25次同时导管插入和拔除操作，14例持续性非卧床腹膜透析（CAPD）患者进行了15次。在CCPD患者中，24例在1.0±0.1天后重新开始腹膜透析。1例患者有足够的残余肾功能，在第10天前停用CCPD。10例CAPD患者（11次操作）在操作后1.3±0.2天开始APD，此后7.1±0.6天开始CAPD。3例CAPD患者选择血液透析，并在术后10.0±2.1天重新开始CAPD。1例患者术后次日继续进行CAPD。除了轻微并发症（如体位性引流问题）外，2例患者出现透析液渗漏。2例患者在术后30天内发生腹膜炎，其中1例与操作有关。1例患者在操作后2周出现严重下消化道出血，与导管更换无关。最终，40次操作中有38次患者能够成功继续腹膜透析。我们得出结论，对于导管相关感染患者，在不中断腹膜透析的情况下同时插入和拔除腹膜透析导管是一种安全的操作。
