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. 2024 Mar 20;56(8):2733–2741. doi: 10.1007/s11255-024-04023-7

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© The Author(s) 2024

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 1 — Flowchart regarding the management of tunnel infection unresponsive to medical therapy with concomitant superficial cuff infection, but without ultrasonographic evidence of infection spreading beyond the superficial cuff and an exit-site/superficial cuff distance greater than 2 cm. CUFF-REMOVAL exit-site relocation by external splicing and cuff removal, ES exit-site, PD peritoneal dialysis, Sup. Cuff superficial cuff, TI tunnel infection. *The extent of the infectious process should be assessed by physical exam (searching for erythema, swelling, induration, or tenderness over the subcutaneous pathway) and by ultrasonographic evaluation (detection of hypoechogenic area between the tube/cuff of the catheter and the surrounding tissues with a diameter > 2 mm) [modified by [11]]