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The resulting repaired catheter is shorter&#44; but remains functional<span class="elsevierStyleSup">1</span>&#46; However&#44; when damage occurs at a more proximal point of the catheter&#44; near the exit site&#44; it is usually necessary to interrupt the procedure and remove the catheter&#46;</p><p class="elsevierStylePara">We present our experience with the repair of damaged catheters without removing them and keeping patients on peritoneal dialysis &#40;PD&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">MATERIAL AND METHOD</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">Quinton<span class="elsevierStyleSup">&#8482;</span> Peri-Patch Repair Kit &#40;Quinton Instrument Co&#46;&#44; Tyco Healthcare Group LP&#46; Mansfield&#44; MA&#46;&#44; USA&#41; contains a silicone catheter segment with a threaded connector at one end and a beta-cap adapter inserted into the other end&#46; The kit also includes a plastic mould with a locking ring&#44; a catheter plug&#44; a clamp and sterile adhesive &#40;Figure 1A&#41;&#46;</p><p class="elsevierStylePara">The repair procedure must be performed using an aseptic technique in a sterile field&#46; Alcohol-based disinfectants should not be used as they adversely affect the adhesive process&#44; and catheter segments on which we need to work must be completely dry before applying the adhesive&#46;</p><p class="elsevierStylePara">Repair procedure steps&#58;</p><p class="elsevierStylePara">- The catheter must be clamped between the skin and the site of damage or breakage&#46;</p><p class="elsevierStylePara">- Cut the catheter carefully at the site of damage or breakage with sterile scissors trying to preserve as great a length as possible&#46;</p><p class="elsevierStylePara">- The catheter segment that comes in the kit is connected to the original indwelling catheter by its threaded end&#46; The connection must be firm and secure &#40;Figure 1B&#41;&#46;</p><p class="elsevierStylePara">- Remove the clamp from the catheter and allow drainage of several ml of dialysate so as to wash away any contaminants at the new joint&#46; Next&#44; close the added catheter segment with the plug&#46;</p><p class="elsevierStylePara">- After making sure that the point of the new connection is completely dry&#44; mould plastic around the site securing it with the locking ring &#40;Figure 1C&#41;&#46;</p><p class="elsevierStylePara">- Sterile silicone adhesive is applied through the locking ring to fill the mould &#40;Figure 1D&#41;&#46;</p><p class="elsevierStylePara">- A new transfer line or catheter extension segment is connected&#44; following the usual steps for this process&#44; to the silicone segment added&#46;</p><p class="elsevierStylePara">- The plastic mould can be removed after 48-72 hours&#46;</p><p class="elsevierStylePara">- The manufacturer&#39;s instructions indicate that PD can be resumed after completing all the steps and if the adhesive has solidified&#44; but we prefer to wait 24 hours before restarting the procedure&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">DESCRIPTION OF THE CASES</span><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Patient 1</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">Male&#44; 63 years of age&#44; with a self-locating catheter and on PD for one month&#46; During an exit site dressing change&#44; the patient accidentally cut the catheter with scissors about 5cm from the skin&#46; After clamping the catheter&#44; the procedure described above in the Material and Method section was performed&#46; Prophylactic antibiotic was administered&#46; PD was resumed normally after 24 hours and no episodes of peritonitis were recorded after nine months of follow-up &#40;Figure 2&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Patient 2</span><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">Male&#44; 40 years of age&#44; with a swan neck catheter with two Dacron cuffs implanted six years earlier&#46; After three years on PD&#44; the external cuff was extruded as part of the treatment of a recurrent infection of the exit site&#46; Three years later&#44; during a periodic review&#44; inspection revealed a small hole near the remains of the extruded outer cuff&#46; The hole did not reach the lumen of the catheter&#44; but to prevent complete perforation we decided to reinforce this point&#46; To do this&#44; we wrapped the site of the hole with the mould and filled this with silicone adhesive&#46; The kit catheter extension segment was not necessary in this case&#44; as there was not a complete breakage&#46; Dialysis was not interrupted and there were no infectious complications after the procedure&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Patient 3</span><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">Female&#44; 57 years of age&#44; with a self-locating catheter&#46; After four years on PD&#44; a small interruption or disappearance of the catheter radiopaque line was seen&#44; but careful examination of the catheter revealed no leaks&#46; However&#44; nine months later&#44; the patient consulted due to dialysate leakage through a hole located just at the point where the radiopaque line had disappeared&#46; The patient was administered prophylactic antibiotics and we proceeded to repair the catheter&#44; using the kit catheter extension segment&#46; No further complications were reported&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Patient 4</span><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">Male&#44; 74 years of age&#44; had a self-locating catheter in place for three years&#46; External cuff extrusion was noted due to a recurrent infection of the exit site&#46; The procedure was performed without incident&#44; but the &#34;shaving&#34; of extruded cuff was difficult because the Dacron was firmly stuck to the catheter and there was a risk of inducing a perforation or rupture of the catheter&#46; Rough and dirty remnants of the external cuff remained too close to the exit site and could cause a new infection&#44; either by exit site irritation or colonisation&#46; For this reason&#44; we decided to coat them with silicone using the plastic mould &#40;Figure 3&#41;&#46; As there was no breakage&#44; it was not necessary to use the kit catheter extension segment in this case and dialysis was not interrupted&#46; The patient suffered no infection after the procedure&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Patient 5</span><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">Male&#44; 46 years of age&#44; on automated PD for five years with a self-locating catheter&#46; After four years on PD&#44; during a periodic exam a small interruption or disappearance of the catheter radiopaque line was found&#44; but leakage of dialysate was ruled out and the procedure continued without incident&#46; Several months later&#44; the patient experienced a greater number of cycler alarms&#44; mostly due to problems during drainage&#46; A catheter inspection showed that the missing portion of the radiopaque line had increased&#44; and the catheter collapsed at that point when suction was applied &#40;as happens with the cycler during the drainage phase&#41; &#40;Figure 4A and Figure 4B&#41;&#46; Once again&#44; we used the repair kit&#44; this time with some variations&#46; We clamped the catheter near the skin and disconnected the transfer line&#46; Then&#44; we insufflated air through the lumen with a syringe and placed a new clamp&#44; leaving the problem area between the clamps inflated&#46; We placed the silicone mould around this dilated area and filled it with adhesive glue &#40;Figure 4 Figure 4C and 4D&#41;&#46; We put in place a new transfer line&#46; After 24 hours&#44; the clamps were removed and the patient resumed treatment with a significant reduction in the number of alarms&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">CLINICAL SUMMARY</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">We have presented five repair procedures carried out on five peritoneal catheters&#46;</p><p class="elsevierStylePara">The patients&#8217; mean age &#40;4 men and 1 woman&#41; was 56 years&#44; and three of them were on automated PD and two on continued ambulatory PD&#46; The catheters had been in place for one month&#44; six years&#44; four years and nine months&#44; three&#44; and five years&#44; respectively&#46;</p><p class="elsevierStylePara">In patients 1 and 3&#44; the broken catheters were repaired adding the kit catheter extension segment&#46; Patients were given prophylactic antibiotic treatment not because of the repair procedure&#44; but due to the accidental disconnection&#46; In patients 2 and 4&#44; the kit was used to prevent future complications&#46; Our personal application in patient 5 eased their problems with the cycler&#46;</p><p class="elsevierStylePara">None of the patients experienced peritonitis or other infectious complications or dialysate leaks after several months of follow-up&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">Although PD has certain advantages with respect to haemodialysis&#44; it continues to be underutilised&#46; One of the reasons for this low utilisation is the high dropout rate due to technical problems related to the catheter&#46; In many cases&#44; the catheters are removed rather than trying to perform rescue procedures&#44; and the patients are transferred to haemodialysis&#46; The repair of damaged catheters is&#44; therefore&#44; an important procedure for keeping the patients on PD&#46;</p><p class="elsevierStylePara">Catheter breakage or damage may be due to natural wear and tear of the catheter after prolonged use&#44; although the repeated use of clamps&#44; or repeated contact with disinfectants have also been considered predisposing factors&#46; The application of mupirocin&#44; used as coadjuvant treatment for exit site infection has been associated with the occurrence of permanent structural changes in the catheter&#44; such as opacity&#44; deformity and dilation&#44; although damage caused by mupirocin is more often described with polyurethane catheters&#46; Exit site colonisation and infection by gram-negative bacteria can also be a predisposing factor for catheter breakage&#46; And silicone chemical weakening caused by interaction with iodine disinfectants can be exacerbated by mechanical stresses&#44; eventually causing breakage&#46; Occasionally&#44; some batches of defective catheters can escape quality control in the production line and defective catheters are distributed to dialysis centres<span class="elsevierStyleSup">1-7</span>&#46;</p><p class="elsevierStylePara">That said&#44; the most common cause of catheter damage is the use of scissors or sharp objects during dressing changes&#46; For this reason&#44; during initial patient training emphasis should be placed on measures to prevent catheter damage&#46; Using scissors or other sharp objects to cut bandages near a PD catheter is clearly undesirable and should be banned&#46; Furthermore&#44; alcohol or iodine are no longer recommended for daily care of the exit site&#46;</p><p class="elsevierStylePara">Catheter breakage almost always causes contamination and a high risk of peritonitis&#46; Therefore&#44; it is important to repair it quickly&#46;</p><p class="elsevierStylePara">When the catheter is damaged near the exit site&#44; use of the repair kit is an alternative to catheter removal&#46; Although this kit has been available for many years&#44; we have found few references to its use<span class="elsevierStyleSup">2-4</span>&#46; It is easy to use and the risk of induced peritonitis is not greater than when an extension is changed&#46;</p><p class="elsevierStylePara">In summary&#44; the repair of a damaged catheter using the repair kit extends the life of the catheter and prevents its removal&#44; allowing the patient to continue on PD&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">The authors declare that they have no conflicts of interest related to the contents of this article&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12486&#95;19157&#95;64779&#95;en&#95;ref&#46;1248632237&#95;12486&#95;19115&#95;55621&#95;es&#95;12486&#95;figura1&#46;jpg" class="elsevierStyleCrossRefs"><img src="12486_19157_64779_en_ref.1248632237_12486_19115_55621_es_12486_figura1.jpg"></img></a></p><p class="elsevierStylePara">Figure 1&#46; </p><p class="elsevierStylePara"><a href="grande&#47;12486&#95;19157&#95;64780&#95;en&#95;ref&#46;1248632237&#95;12486&#95;19115&#95;55622&#95;es&#95;12486&#95;figura2&#46;gif" class="elsevierStyleCrossRefs"><img src="12486_19157_64780_en_ref.1248632237_12486_19115_55622_es_12486_figura2.gif" alt="Catheter repaired using the kit catheter segment"></img></a></p><p class="elsevierStylePara">Figure 2&#46; Catheter repaired using the kit catheter segment</p><p class="elsevierStylePara"><a href="grande&#47;12486&#95;19157&#95;64783&#95;en&#95;ref&#46;1248632237&#95;12486&#95;19115&#95;55623&#95;es&#95;12486&#95;figura3&#46;gif" class="elsevierStyleCrossRefs"><img src="12486_19157_64783_en_ref.1248632237_12486_19115_55623_es_12486_figura3.gif"></img></a></p><p class="elsevierStylePara">Figure 3&#46; </p><p class="elsevierStylePara"><a href="12486&#95;19157&#95;64782&#95;en&#95;ref&#46;1248632237&#95;12486&#95;19115&#95;55624&#95;es&#95;12486&#95;figura4&#46;doc" class="elsevierStyleCrossRefs">12486&#95;19157&#95;64782&#95;en&#95;ref&#46;1248632237&#95;12486&#95;19115&#95;55624&#95;es&#95;12486&#95;figura4&#46;doc</a></p><p class="elsevierStylePara">Figure 4&#46; 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