Functional
peritoneal dialysis catheter loss due to persistent or recurrent
peritonitis is a common clinical problem in paediatric patients. To examine the effect of positioning of the cuff on
infection and loss rate we compared
catheters where the cuff was buried in the rectus sheath (deep cuffs) with those where the cuff was sutured to the external oblique muscle, just below the subcutaneous fascia (superficial cuffs). Of 62
catheters inserted into 35 patients (median age 7.76 yrs, range 0-17 yrs) 28 were lost through
peritonitis of which 19 (68%) were due to Staph. aureus
infection, usually associated with exit site colonisation or
infection. 12 out of 20
catheters with superficial cuffs were lost through
infection compared with 16 out of 42 with deep cuffs (relative risk reduction 37%, p = ns). Controlling for patient age and infecting organism made no difference to this statistic. 15 out of 21
catheters inserted into patients < 2yrs of age were lost through
peritonitis compared to 13 out of 41
catheters inserted into patients over 2 yrs of age (p = 0.037). We conclude that although siting of the
Dacron cuff in the rectus sheath is somewhat protective against penetrating
infection this is still a major problem in the infant and young child where alternative strategies for the prevention of Staph. aureus
infection need to be sought.