Dialysis catheters

In primary peritonitis, bacteria may enter the abdomen via the bloodstream or the lymphatic system, by transmigration through the bowel wall, through an indwelling peritoneal dialysis catheter, or via the fallopian tubes in females. 

Marsala M, Malmberg AB, Yaksh TL (1995) A chronic spinal dialysis catheter for use in the unanesthetized rat Methodology and application. / Neurosci Methods 62 43-53. 

Wilcox, CM., Woods, B.L., Mixon, H.T. Prospective evaluation of a peritoneal dialysis catheter system for large volume paracentesis. Amer. J. Gastroenterol. 1992 87 1443-1446... 

A 58-year-old woman with end-stage renal insufficiency secondary to diabetic nephropathy developed abdominal wall cellulitis 4 days after insertion of a peritoneal dialysis catheter. She was given vancomycin, cefepime, and metronidazole in reduced doses (doses not stated) and 2 days later developed dysarthria, an intention tremor, dysmetria, and dysdiadochokinesia. Routine biochemical tests were unchanged and a CT scan of the brain was unremarkable, but an MRI scan showed cerebral and cerebellar atrophy with multifocal ischemic glial lesions. Metronidazole was withdrawn and 2 days later her symptoms and signs had completely resolved. 

Rinaldi S, Sera RVerrina E, et al. Chronic peritoneal dialysis catheters in children a fifteen-year experience of the Italian Registry of Pediatric Chronic Peritoneal Dialysis. Perit DialInt. 2004 24 481-486... 

C Treatment for catheter-related infections is often initiated empirically, with definitive therapy based on culture results and susceptibility. Dialysis catheters are usually permanently inserted lines, and patients on chronic hemodialysis are at higher risk for developing catheter-related infections secondary to staphylococcal species, particularly coagulase-negative staphylococci. Oral vancomycin is not appropriate because it does not achieve adequate blood levels to treat systemic infections. 

Fever and chills <1 Endotoxin release Infection of dialysis catheter... 

FIGURE 45-3. Diagram of the placement of a peritoneal dialysis catheter through the abdominal wall into the peritoneal cavity. 

The number of people diagnosed with end-stage kidney disease (ESKD) in 2002 exceeded 400,000. There were over 100,000 new cases of ESKD in 2002. The primary therapeutic options for these individuals are hemodialysis, peritoneal dialysis, and/or renal transplantation. Renal transplantation is the preferred long-term therapeutic option for most patients with ESKD because it provides patients with the greatest potential improvement in overall quality of life. Dialysis catheter-related infections, update peritoneal dialysis-associated peritonitis, and scheduled dialysis treatments are avoided, and dietary restrictions are fewer. While the analysis of quality of life is complex, patients generally report improved quality of life following transplantation as compared with patients on maintenance dialysis. ... 

The immune system is also compromised in uremia. That and the use of dialysis catheters and synthetic grafts, the frequent blood transfusions, the exposure to nosocomial organisms during repeated hospitalization, the presence of anemia and malnutrition, and the immunocompromised state associated with certain renal diseases (nephrotic syndrome, lupus erythematosus) all conspire to make infection a major cause of mortality, accounting for 15-20% of uremic deaths. Pyogenic infections are facilitated by impaired neutrophil adherence and chemotaxis (L7, S27), blunted antibody response (B15), and defective phagocytosis by macrophages due to decreased Fc-receptor activity (R19). 

Coatings for dialysis catheters made from silicone tubing. 

Kubey W Lunebueg P, Ericson S, Brown J and Holmes CJ (1995) A longitudinal in vitro antimicrobial evaluation of two silver polymer surface treatments for peritoneal dialysis catheters. Adv Peril Dial 11 193-197. 

Gray, R. J., Levitin, A., Buck, D., Brown, L. C., Sparling, Y. H., Jablonski, K. A., Fessahaye, A., and Gupta, A. K., Percutaneous fibrin sheath stripping versus transcatheter urokinase infusion for malfunctioning well-positioned tunneled central venous dialysis catheters A prospective, randomized triaL /- Vase. Interv. Radiol., 2000 11(9) 1121-1129. 

Heparinization of CVCs and dialysis catheters resulted in a significant reduction of CR-Is, as seen in a randomized-controlled clinical trial of heparin-coated and uncoated nontunneled CVCs inserted in 246 patients and a retrospective comparative analysis of coated and uncoated tunneled dialysis catheters. ... 

Jain G, AUon M, Saddekni S, et al. Does heparin coating improve patency or reduce infection of mnneled dialysis catheters Clin JAm Soc Nephrol September 2009 4(11) 1787-90. 

Coatings for dialysis catheters made from sihcone tubing Coatings for surgical screws and wires Cochlear implants Bone graft substitutes Bone tissue engineering scaffolds... 

Aflori, M. Surface characterization of peritoneal dialysis catheter containing silver nanoparticles. Rev. Roum. Chim. 59 no. 6-7 (2014) 523-526. 

The intraperitoneal (i.p.) route of administration is particularly advantageous if access to the cavity already exists (i.e., a peritoneal dialysis catheter) and if the infection or disease process is confined to the cavity. Medication levels in the i.p. solution can be maintained one to two orders of magnitude above toxic levels in the plasma. Transfer to the systemic circulation is relatively slow, and peak concentrations in the plasma will be a fraction of what they would be if the same dose were administered i.v. This provides for maximal pharmacologic activity locally while sparing the remainder of the body from the toxic side effects. The pharmacokinetic advantage of regional administration into the peritoneal cavity (or any body cavity) over that of intravenous administration can be calculated by... 

Figure 4 (A) Chest radiograph of a patient with MPO-ANCA vasculitis who presented with pulmonary hemorrhage and renal failure, demonstrating diffuse alveolar shadowing. Additionally, a central venous dialysis catheter is visible in the right internal jugular vein. (B) CT scan of a patient with pulmonary fihrosis diagnosed concurrently with their renal failure due to MPO-ANCA-associated vasculitis, demonstrating the characteristic hon-eycomhing pattern.

Antibiotic-lock therapy (ALT) is used in addition to systemic treatment for CVC-related infections. After filling both catheter lumens with a mix of antibiotic and anticoagulant at the end of dialysis (catheter locking), antibiotic concentrations inside the catheter reach very high levels, much higher than the con-... 

Martinez Salazar et al. [60] reported no bleeding complications after 53 tunneled hemodialysis catheter procedures performed in dialysis patients on clopidogrel therapy, indicating that cardiologic indications to continue clopidogrel after cardiac procedures can be followed with low risks of complications during dialysis catheter procedures. 

Systemic anticoagulation for the prevention of dialysis catheter thrombosis is controversial for its inherent risk-benefit issues while it may improve catheter survival, it can also increase the risk of side effects, such as bleeding and cardiovascular calcifications due to inhibition of vitamin K-dependent proteins such as MGP (Matrix Gla protein) [67, 68]. 

Nielsen J, Ladefoged SD, Kolmos HJ Dialysis catheter-related septicaemia - focus on Staphylococcus aureus septicaemia. Nephrol Dial Transplant 1998 13 2847-2852. 

Fong IW Prevention of haemodialysis and peritoneal dialysis catheter related infection by topical povidone-iodine. Postgrad Med J 1993 69(suppl 3) S15-S17. 

Hemmelgam BR, Moist LM, Lok CE, et al Prevention of dialysis catheter malfunction with recombinant tissue plasminogen activator. N Engl J Med 2011 364 303-312. 

The peritoneal dialysis access catheter placement simulation is ideal to teach aviation safety principles emphasizing the importance of knowing basic facts, such as the tools and instruments needed for the procedure and how the use of checklists improves patient safety. An abdominal simulator is currently under development for the laparoscopic technique of placing the peritoneal dialysis catheter [12]. 

Jwo SC, Chen KS, Lee CC, Chen HY Prospective randomized study for comparison of open surgery with laparoscopic-assisted placement of Tenckhoff peritoneal dialysis catheter - a single center experience and literature review. J Surg Res 2010 159 489-496. Wright MJ, Bel eed K, Johnson BF, Eading-ton DW, Sellars L, Farr MJ Randomized prospective comparison of laparoscopic and open peritoneal dialysis catheter insertion. Perit Dial Int 1999 19 372-375. 

Danielsson A, Blohme L, Tranaeus A, Hy-lander B A prospective randomized study of the effect of a subcutaneously buried peritoneal dialysis catheter technique versus standard technique on the incidence of peritonitis and exit-site infection. Perit Dial Int 2002 22 211-219. 

Polakovic V, Svara F, DvofakovA M Dialysis catheter insertion with and without peel-away sheaths. Nephrol Dial Transplant 2007 22 2359. 

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