title: Pelvic drainage during removal of dialysis catheter decreases the risk of subsequent intra-abdominal complications in refractory peritoneal dialysis-related peritonitis.
abstract: OBJECTIVE
  Some patients with refractory peritoneal dialysis-related peritonitis continue to develop intra-abdominal complications despite removal of the peritoneal catheter. Repeated percutaneous drainage or open laparotomy is often required, and mortality is not uncommon. The benefits of pelvic drainage placement during catheter removal in decreasing these complications and interventions remain unproven.
  
  
  METHODS
  Forty-six patients with refractory peritonitis who underwent removal of a Tenckhoff catheter between 1991 and 2013 were reviewed retrospectively. Twelve patients had pelvic drainage using closed active suction devices during catheter removal (drainage group). The remaining 34 patients underwent catheter removal without drainage (non-drainage group). The outcomes measured were the development of intra-abdominal complications and the requirement for repeated percutaneous drainage or open laparotomy within 90 days after the catheter removal.
  
  
  RESULTS
  Baseline characteristics were similar with the exception of a higher median number of previous peritonitis episodes in the drainage group compared with the non-drainage group (2 vs 0, P = 0.02). During the follow-up period, intra-abdominal complications occurred in 15 (44%) of 34 patients in the non-drainage group, compared with one (8%) of 12 patients in the drainage group (P = 0.03). Twelve (35%) patients in the non-drainage group required repeated percutaneous drainage or open laparotomy for management, compared with zero (0%) patients in the drainage group (P = 0.02). Drain tubes were removed at a median of 6 days (inter-quartile range: 5-10) without complications.
  
  
  CONCLUSIONS
  In the management of refractory peritonitis, pelvic drainage during removal of dialysis catheter decreases the risk of subsequent intra-abdominal complications and invasive interventions.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Chih-Yang
authors.initials: CY
authors.lastname: Hsu
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Wei-Chieh
authors.initials: WC
authors.lastname: Huang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Chun-Kai
authors.initials: CK
authors.lastname: Huang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Chien-Wei
authors.initials: CW
authors.lastname: Huang
authors.affiliation: Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Nan-Hua
authors.initials: NH
authors.lastname: Chou
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.|National Yang-Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Po-Tsang
authors.initials: PT
authors.lastname: Lee
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.|National Yang-Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Hua-Chang
authors.initials: HC
authors.lastname: Fang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.|National Yang-Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Kang-Ju
authors.initials: KJ
authors.lastname: Chou
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.|National Yang-Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Chien-Liang
authors.initials: CL
authors.lastname: Chen
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D003131:Combined Modality Therapy; D020878:Device Removal / Q000009:adverse effects; D004322:Drainage / Q000009:adverse effects; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000295:instrumentation*; D010538:Peritonitis / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: catheter removal; dialysis; drainage; peritonitis