Is it safe to simultaneously remove and replace infected peritoneal dialysis catheters? Review of the literature and suggested guidelines.

Since the introduction of Y-connector technology and the subsequent reduction in the frequency of peritonitis, catheter-related infections have become the primary infectious complication in patients on peritoneal dialysis (PD). Such infections may lead to prolonged morbidity, recurrent peritonitis, and catheter failure. Despite appropriate treatment of catheter-related infections, removal of the catheter is sometimes necessary. The timing of catheter removal and replacement has been the focus of significant discussion. The International Society for Peritoneal Dialysis recommends a 3-week interval, but also allows for individualized timing. Long staging periods present problems that simultaneous removal and replacement (SRR) of the catheter may obviate. Here, we review a body of literature on SRR and present guidelines as to when SRR of an infected PD catheter may be considered a safe alternative to a staged procedure.