Modified technique of continuous ambulatory peritoneal dialysis catheter insertion in the pediatric population

Objectives: 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. Material and 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. Conclusion: 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. (C) 2014 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.