HDCN Article Review/Hyperlink

Ahmed Z, Choudhury D, Lee J, Girgis H

The role of curettage in the care of persistent exit-site infection in CAPD patients

Perit Dial Int (Mar) 17:195-197 1997

Exit site infection is a pesky problem. As long as the cuff is not extruded, one treats with local or systemic antibiotics, and a variety of different local treatments, including chlorhexidine, antibiotic creams, hypertonic saline soaks, or dilute hydrogen peroxide.

In this interesting letter to the editor, in 12 patients, Ahmed and colleagues have tried yet another adjunctive maneuver; they use a small bone curette and actually scrape the inside of the superficial part of the catheter tunnel. They first cleaned the exit site and sinus tract with betadine soaked cotton tipped applicators before proceeding to the curettage, which they did after giving 1% Lidocaine for local anesthesia. Also, in 4 patients a tight exit site had to be excised to permit curettage. The latter was continued until bleeding occurred. Curettage also was used to remove any protruding granulation tissue. Iodoform packing was applied when the wound was deep and wide. In the first 5 patients, curettage was followed by flushing with antibiotic- containing saline solution and systemic antibiotics. In the remainder, this was not done.

Ten of the 12 superficial exit site infections were cured, which seems to be a good result. Of course the study was not controlled, but this seems like a neat idea. (John T. Daugirdas, M.D., University of Illinois at Chicago)