Indications for removal of peritoneal dialysis catheters include: 1. difficult to control multiple peritonitis, especially mycobacterial peritonitis; 2. difficult to control tunneling or tunnel infection; 3. poor drainage of peritoneal dialysis fluid and failure to restore normal drainage despite treatment by other methods; 4. successful renal transplantation or need to switch to hemodialysis; 5. those who can be removed from peritoneal dialysis for other reasons such as recovery of renal function.
For recurrent peritonitis, refractory peritonitis, mycobacterial peritonitis, refractory catheter infection and refractory tunnel infection, as the pathogenic bacteria are often attached to the catheter wall, it is difficult to control the infection with antibiotics alone, all of them should be removed from the peritoneal dialysis catheter in time to control the infection as soon as possible and protect the peritoneal function from further damage. In general, most peritonitis improves within 72 hours after antibiotic treatment, and if treatment remains ineffective for 5 to 7 days, catheter removal needs to be considered. In addition, tunnel infection is usually poorly treated, and early extubation should be performed if local dressing changes and antibiotic therapy are ineffective for two weeks. When the catheter is removed for infectious reasons, the end of the removed catheter should be cut for bacterial culture + drug sensitivity test to understand the causative organism causing the infection and to guide the clinician in adjusting the medication. In cases where peritoneal dialysis is terminated for other reasons and the catheter needs to be removed, no antibiotic therapy is required after removal.
In addition, for poor drainage of peritoneal dialysis fluid due to large omental wrapping or blockage of the catheter, catheter displacement, etc., if conservative medical management is ineffective, the original catheter can be removed and reinserted so that peritoneal dialysis can be resumed as soon as possible.