Removal and replacement of Tenckhoff catheter at a single operation: successful treatment of resistant peritonitis in continuous ambulatory peritoneal dialysis.

8 episodes of persistent and 4 of recurrent bacterial peritonitis in 11 patients on continuous ambulatory peritoneal dialysis (CAPD) were treated successfully by the removal and immediate replacement of the Tenckhoff catheter. Intraperitoneal antibiotics, which had previously failed to produce clinical resolution of the peritonitis, were continued unchanged. Dialysate culture yielded Staphylococcus epidermidis (3 cases), Staphylococcus aureus (1 case), pseudomonas species (5 cases), acinetobacter (1 case), and no growth in 2 cases. Clinical and microbiological resolution was achieved in all 12 cases within 36 h. CAPD continued uninterrupted in 10 cases. 1 patient required temporary haemodialysis for 6 weeks because of dialysate leakage and later restarted CAPD. 1 patient chose haemodialysis as his long-term treatment when his new catheter failed mechanically on the second postoperative day. Replacement of the Tenckhoff catheter at a single operation without interrupting CAPD reduces the demand which temporary haemodialysis of these patients makes on centre dialysis facilities and may preserve the peritoneal cavity for dialysis by preventing the formation of adhesions.