This article is also accessible online at: http://BioMedNet.com/karger Dear Sir, Rupture of peritoneal catheters is a very unusual complication that can occur as a result of traumatic accidents. Recently, we had to face an unexpected ‘epidemic’ of apparently nontraumatic peritoneal catheter ruptures. Therefore, we learned with great interest that a similar problem has occurred in a French centre, as published in this journal by Guiserix [1]. The cause of this cluster of ruptures has remained unexplained, but we would like to give some details of our experience that, for some aspects, differs from that described by Guiserix. Our peritoneal dialysis program consists of 50 continuous ambulatory peritoneal dialysis patients on whom, as in the French center, we have always been using the classic double-cuff Tenckhoff catheter sterilised with ethylene oxide. Since 1980, the catheter has been produced in Italy by a unique manufacturer, while those used in the French center are manufactured in North America. We have always used the same Y-set system using as disinfectant Amuchina, a solution of hypertonic sodium chloride that by partial electrolysis generates sodium hypochlorite [2]. In the French center, peritoneal dialysis was performed with the UV Flash system which does not imply the use of chemical disinfectant agents. From 1980 to 1996, we have observed one single rupture of peritoneal catheter over 266 catheters implanted that was recorded as of probable traumatic origin. During the past 16 months, there was a dramatic rise in the frequency of rupture not associated with a definite traumatic event: 5 episodes in 4 patients. Before the rupture, the catheters had been in situ for 31, 10, 8, 7 and 4 months, respectively. In each case the catheter was shortened and the connection restored. There were 3 cases of peritonitis, despite antibiotic prophylaxis with intraperitoneal teicoplanine bolus, and in 1 case, the peritoneal catheter was replaced. There are two other important differences with Guiserix’s experience. First, the typical location of spontaneous rupture, which was at the junction between the peritoneal catheter and the titanium nozzle in Guiserix’s cases and at 3–4 cm from the exit site in our cases. In our experience, therefore, the point of rupture is more proximal and is generally not subject to mechanical insults because it is fixed to the abdominal wall with a dressing. Second, the French group used 10% iodized polyvidone to disinfect the titanium nozzle area at the time of the periodic change of transfer set, whereas we have always used Amuchina. Since the manufacturer of the catheter, the connection system, the disinfectant, and the operational procedures have been constant both in the French and our own center, one possibility for explaining the recent epidemics is that occasionally brands of altered silicon may escape quality control checks in the production line and that altered catheters are distributed to dialysis centers. Defective silicon catheters may lose resistance to chemicals used as disinfectants (either iodine, as in the French center, or active chloride, as in our center). Potential liabilities of silicon catheters should be made clearly known. Such information is at present not easily available. We suspect that spontaneous rupture of peritoneal catheters is an underreported complication. We hope that other colleagues who have observed this complication will describe their experience contributing to the understanding and prevention of such a severe technical problem.

We have evaluated a nursing chart for detecting exit site infection in 46 peritoneal dialysis patients. Signs of exit site infection weve observed in 13/46 patients (28%). Using the nursing chart, the agreement between two independent observers was very good in detecting patients with exit site infection (Kappa statistics = 0.84).