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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2014  |  Volume : 25  |  Issue : 1  |  Page : 166-167
Adding peritoneal flush for catheter salvage after early capd peritonitis: A report of two cases


1 Department of Nephrology, Bhopal Memorial Hospital and Research Center, Bhopal - 462038, India
2 Department of Microbiology, Bhopal Memorial Hospital and Research Center, Bhopal - 462038, India

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Date of Web Publication7-Jan-2014
 

How to cite this article:
Atlani M, Prabha D. Adding peritoneal flush for catheter salvage after early capd peritonitis: A report of two cases. Saudi J Kidney Dis Transpl 2014;25:166-7

How to cite this URL:
Atlani M, Prabha D. Adding peritoneal flush for catheter salvage after early capd peritonitis: A report of two cases. Saudi J Kidney Dis Transpl [serial online] 2014 [cited 2019 Nov 19];25:166-7. Available from: http://www.sjkdt.org/text.asp?2014/25/1/166/124556
To the Editor,

Early peritonitis in chronic ambulatory peri­toneal dialysis (CAPD) (peritonitis occurring within two weeks of catheter placement) may result in catheter loss in addition to patient sufferings. [1] Pre-operative antibiotics help re­duce the rates of early peritonitis. [2] The treat­ment of early CAPD peritonitis is not well established. In the past, we used the recommen­ded intermittent antibiotic therapy [3] in small-volume (1 L) night dwell, but could not sal­vage the catheters. We used peritoneal lavage (flush) in addition to the recommended anti­biotic therapy in a continuous manner and successfully salvaged the CAPD catheters in two patients.

The two patients underwent Swan neck curl catheter (Quinton) placement through open surgical technique on two different days. Both patients received 1 g IV Cefazolin 3 h before the catheter placement. Inflow and outflow were confirmed soon after placement, and were slightly hemorrhagic but non-turbid. The cathe­ter position was confirmed by an abdominal X-ray and no evidence of gas under diaphragm was found, which ruled out the possibility of visceral perforation.

The first patient on the next day of placement and the second patient two days after the placement of the CAPD catheters developed pain in the abdomen with fever and diarrhea. Peritoneal flushing for both the patients was done on the third day and the fluid was sent for evaluation, which confirmed peritonitis [Table 1]. Both patients were started on three exchanges of 1-L dwells, each for 4 h, and one night dwell of similar volume (CAPD × 3 × 1.25% and one night dwell). Before each exchange, peritoneal flush was performed with 1 L of CAPD fluid (filled in and drained imme­diately). Antibiotics (inj. Cefazolin 125 mg and inj. Ceftazidime 125 mg) were added to the rest of the CAPD exchanges. Both patients im­proved with the empiric antibiotic therapy and lavage. CAPD fluid culture grew coagulase-negative Staphylococcus aureus and Acitenobacter from the first and the second patients, respectively. The peritonitis resolved completely by the 14th day in both patients and did not recur despite six months of follow-up.
Table 1: CAPD Fluid examination

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Early peritonitis after catheter placement is usually secondary to poor surgical technique.

Repeated peritoneal flush and continuous antibiotic therapy helped in eradicating infec­tion, and we were able to salvage the catheter. In the initial days of CAPD, initial 24-h lavage was used before starting antibiotic therapy, but was not found to be useful. [4] Here, we did not use 24-h lavage; instead, we flushed the peri­toneum with 1 L fluid, which reduced the bacterial burden and helped eradicate the in­fection, and administered the antibiotics after­wards.

 
   References Top

1.Wikdahl AM, Engman U, Stegmayr BG, Sorenson JG. One-dose cefuroxime I.V. and I.P. reduces microbial growth in PD patients after catheter insertion. Nephrol Dial Transplant 1997;12:157-60.  Back to cited text no. 1
    
2.Gadallah MF, Ramdeen G, Mignone J, Patel D, Mitchell L, Tatro S. Role of preoperative antibiotic prophylaxis in preventing postope­rative peritonitis in newly placed peritoneal dialysis catheters. Am J Kidney Dis 2000;36: 1014-9.  Back to cited text no. 2
[PUBMED]    
3.Li PK, Szeto CC, Piraino B, et al. Adult Peritoneal Dialysis-related Peritonitis Treat­ment Recommendations: 2010 Update. Perit Dial Int 2010;30:393-423.  Back to cited text no. 3
[PUBMED]    
4.Ejlersen E, Brandi L, Lokkegaard H, Ladefoged J, Kopp R, Haarh P. Is initial (24 Hours) Lavage necessary in treatment of CAPD peritonitis? Perit Dial Int 1991;11:38-42.  Back to cited text no. 4
    

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Correspondence Address:
Mahendra Atlani
Department of Nephrology, Bhopal Memorial Hospital and Research Center, Bhopal - 462038
India
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DOI: 10.4103/1319-2442.124556

PMID: 24434404

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