Prevention of Postoperative Peritoneal Dialysis Catheter-Related Infections

Abstract

Catheter-related infections represent a significant complicaton of peritoneal dialysis therapy for end-stage renal disease, and may even supplant peritonitis as the Achilles’ heel. While the true incidence of all types of postoperative catheter-placement infections is unknown, it is reported that approximately 10% of exit-site infections occur in the immediate postoperative period, prior to healing and the establishment of barriers to microorganism invasion. Generally, little attention is given to this fact, and there exists no standardized procedure for the care of the operative wound and exit site. We evaluated a postoperative catheter-care protocol in 111 consecutive catheter placements. Ninety-seven were placed surgically and 14 with a peritoneoscope. Emphasizing strict aseptic technique, catheter immobilization, and avoidance of contamination, we observed no early and only two late postoperative infections. Our patients were from two different medical centers and we did not attempt to control for exit-site location, type of catheter, or technique and location of placement. Prophylactic antibiotics were utilized in 88%. We believe that our protocol was responsible for our low postoperative infection rate.