title: Modified technique of continuous ambulatory peritoneal dialysis catheter insertion in the pediatric population.
abstract: OBJECTIVE
  To assess whether placement of a superficial cuff deeper to the external oblique aponeurosis reduces cuff extrusion and exit site infection in peritoneal catheter insertion in children.
  
  
  METHODS
  In 2013, a total of fourteen children underwent open continuous ambulatory peritoneal dialysis catheter insertion using Tenckhoff double cuffed catheters. The initial eight patients underwent a conventional technique and developed exit site infection and cuff extrusion. In six other patients, the technique was modified by placing the superficial cuff deeper to the external oblique aponeurosis.
  
  
  RESULTS
  In the former group, three patients developed cuff extrusion, whilst none developed it in the latter, modified group.
  
  
  CONCLUSIONS
  Continuous ambulatory peritoneal dialysis catheter insertion in children is associated with superficial cuff extrusion as a complication. It can be prevented by placing the cuff deeper to the external oblique aponeurosis instead of placing it in the conventional subcutaneous plane. In early experiences with this innovative technique, results have been promising. Randomized controlled trials can thus be undertaken to strengthen this finding.
authors.affiliation: Department of Urology, Meenakshi Mission Hospital and Research Centre, Lake Area, Melur Road, Madurai 625107, Tamil Nadu, India. Electronic address: drravi99@rediffmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Ravichandran
authors.affiliation: Department of Urology, Meenakshi Mission Hospital and Research Centre, Lake Area, Melur Road, Madurai 625107, Tamil Nadu, India. Electronic address: drvikramhn@gmail.com.
authors.forename: H N
authors.initials: HN
authors.lastname: Vikram
authors.affiliation: Department of Urology, Meenakshi Mission Hospital and Research Centre, Lake Area, Melur Road, Madurai 625107, Tamil Nadu, India. Electronic address: golde2003@gmail.com.
authors.forename: T R
authors.initials: TR
authors.lastname: Murali
authors.affiliation: Department of Nephrology, Meenakshi Mission Hospital and Research Centre, Lake Area, Melur Road, Madurai 625107, Tamil Nadu, India. Electronic address: drksampath@gmail.com.
authors.forename: K
authors.initials: K
authors.lastname: Sampathkumar
mesh_terms: D000293:Adolescent; D002404:Catheterization / Q000379:methods*; D002408:Catheters, Indwelling; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D006801:Humans; D007223:Infant; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000295:instrumentation
keywords: CAPD; Children; Continuous ambulatory peritoneal dialysis; Cuff extrusion; Superficial cuff