title: The 'Pull' Technique for Removal of Peritoneal Dialysis Catheters: A Call for Re-Evaluation of Practice Standards.
abstract: ♦ BACKGROUND: The most commonly used peritoneal dialysis (PD) catheters have silicon tubing with attached Dacron cuffs. The current standard of care for PD catheter removal is by complete surgical dissection, withdrawing both the tubing and the cuffs. The intention is to avoid infection of any residual part of the catheter. We retrospectively analyzed our results with the alternative 'pull' technique, by which the silicon tube is pulled out, leaving the Dacron cuffs within the abdominal wall. This technique never gained popularity due to concern that the retained cuffs would get infected. ♦ METHODS: We reviewed our experience from an 18-month period, between January 2014 and June 2015. There were 46 catheter removals in 40 patients. All the catheters were of the double-cuffed coiled Tenckhoff type (Covidien, Dublin, Ireland). ♦ RESULTS: Of the 46 catheter removals by the 'pull' technique, there was only 1 case of retained cuff infection. ♦ CONCLUSIONS: The 'pull' technique is a safe method for Tenckhoff catheter removal with low risk of infection. We strongly recommend it as the procedure of choice.
authors.affiliation: Department of Medicine, Medical Library, Rochester General Hospital, Rochester, NY, USA marvin.grieff@rochesterregional.org.|University of Rochester School of Medicine, Rochester, NY, USA.
authors.forename: Marvin
authors.initials: M
authors.lastname: Grieff
authors.affiliation: Department of Information Technology, Rochester General Hospital, Rochester, NY, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Mamo
authors.affiliation: Department of Nursing, Rochester General Hospital, Rochester, NY, USA.
authors.forename: Gina
authors.initials: G
authors.lastname: Scroggins
authors.affiliation: Department of Surgery, Rochester General Hospital, Rochester, NY, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kurchin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000628:therapy*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D015331:Cohort Studies; D016208:Databases, Factual; D020878:Device Removal / Q000379:methods* / Q000706:statistics & numerical data; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000379:methods; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects / Q000379:methods; D010538:Peritonitis / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D055815:Young Adult
keywords: Dacron; Peritoneal dialysis; Tenckhoff catheter; peritonitis