Abstract: FR-PO474
Embedded Peritoneal Dialysis Catheter: When Things Go Wrong
Session Information
- Home Dialysis - 1
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Ray, Madhab, University of California Davis, Davis, California, United States
- Madan, Niti, University of California Davis, Davis, California, United States
- Ananthakrishnan, Shubha, University of California Davis, Davis, California, United States
Introduction
Embedment of peritoneal dialysis catheter is sometimes used when a patient with ESRD does not need dialysis immediately, but it may be necessary in the months to come. The procedure of embedment is relatively safe and short, gives time to develop a scar around the catheter and, reduces chance of infection and leak. The catheter becomes readily available for use upon externalization of the tip. Various complications including malfunction and infection are seen when an embedded catheter is externalized. However, some embedded catheters are never externalized and thus the procedure becomes a futile exercise. Infection in an unused embedded catheter is rare. We report a case of infection in an embedded PD catheter which was never externalized or used.
Case Description
A 61yr old female with HIV (CD4 928, viral load undetectable, on ABC/3TC/DTG), positive HBV core antibody, hypertension, hyperlipidemia and CKD G5 A3 (due to NSAIDS, hypertension and side effect of HIV medications with secondary FSGS) got an embedded PD catheter placed. Nine months later the patient presented with abdominal pain. She was found to have cellulitis of the abdominal wall adjacent to embedded catheter and the culture of the purulent fluid from incision and drainage along with her blood culture showed MRSA infection. The patient was treated with appropriate course of antibiotics and her catheter was surgically removed without any further complication. She never required dialysis and got living donor kidney transplant 10 months after removal of the PD catheter.
Discussion
Embedment of a PD catheter in patients with ESRD under consideration of peritoneal dialysis has gained popularity. It helps in increasing the acceptance rate of peritoneal dialysis as the modality of choice. It offers readiness and gives opportunity for scarring of the surgical site providing a seal around the catheter and reducing the possibility of infection and leak. However, different studies question the overall benefit of such a procedure for the risk of nonfunction of the exteriorized catheter, infection, catheter being never used because of a transplant or change of dialysis modality to hemodialysis. These different possibilities need to be considered before planning to embed a catheter. The risk of infection increases with the duration of embedment and more so in the immunocompromised patient. Proper case selection is crucial to minimize such risk.