Peritoneal Dialysis Catheter Placement

Peritoneal dialysis catheter placement

A PD catheter is a soft, flexible tube that is placed into the abdominal cavity via a surgical procedure through which dialysate is infused and drained from the peritoneal cavity. It is designed to be used with a peritoneal dialyzer in patients with chronic kidney disease (CKD) or end stage renal disease (ESRD) who needs peritoneal dialysis, a long-term treatment. 

Preparation

The patient undergoes:

• Medical examination, imaging and blood tests.
• Advices in terms of fasting 6 -8 hours before surgery.
• Abdomen is washed, shaved off and made ready.
• As infection prophylaxis, antibiotics can be administered.
• This is done under local anaesthetic (sedation) or general anaesthetic procedures.

Surgical Techniques

One may place peritoneal dialysis catheter with the help of:

Percutaneous (Bedside) Technique

• A needle is put in the peritoneal cavity.
• Guidewire insertion → dilators insertion → Catheter insertion.
• Conducted regularly by nephrologists.

Laparoscopic Procedure 

• Small incisions are made on the abdomen in the shape of keyholes. 
• Camera hooked in to check the peritoneal cavity.
• Inserted under the skin and in the pelvis.

Allows:

• Inspection of adhesions
• Omentopexy (repair of omentum to avoid obstruction)
• Optimal placement

Open Surgical Technique

• A tiny opening brought close to the umbilicus.
• Catheter and peritoneum opened manually.

Catheter Positioning

• The tip of the catheter is inserted in the pelvis (Douglas pouch).

It is fastened on the skin by two cuffs:

• A single deep cuff that was close to the rectus muscle.
• A single superficial cuff around an exit site.
• Catheter flushed and checked.

Completion

• Absorbable sutures are used to close incisions.
• Sterile dressing applied.
• Monitored patient several hours.

Laparoscopic peritoneal dialysis catheter

It offers precise positioning, intra-abdominal problems can be corrected and the likelihood of catheter malfunction is lower as compared to open methods or percutaneous.

Preoperative Preparation

• Health check, blood tests, and abdominal x-rays as necessary.
• Fasting for 6–8 hours.
• Antibiotics administered before surgery.
• The abdomen is washed out and the patient is placed under general anaesthesia. 

Procedure

Port Placement

• Infra-umbilical incision made (510mm).
• CO2 gas used to make pneumoperitoneum.
• The laparoscope was introduced through the primary port.
• There are one or two other tiny ports put in instruments.

Checking the Peritoneal Cavity

Surgeon checks for:

• Adhesions
• Omental overgrowth
• Hernias
• Bowel abnormalities

In case of necessity, adhesiolysis or repair of hernias can take place within the same environment.

Catheter Insertion

• A minor cut is done close to the umbilicus or it can be made below the umbilicus.
• The PD catheter is passed through the peritoneal cavity and laparoscopically.
• Tip of catheter inserted deep in the region of the pelvis (pouch of Douglas) to yield maximum drainage.

Catheter Tunneling and Fixation of Cuffs

• Catheter is subcutaneously tunneled to an exit site that has not been selected where skin folds occur.

Two cuffs are positioned:

• Deep cuff attached to near rectus muscle.
• Superficial cuff positioning around exit site in order to prevent infection.

Testing and Closure

• Saline flushed catheter to ensure inflow/outflow.
• Pneumoperitoneum released.
• Absorbable sutures are used to close ports and exit-site incisions.
• Sterile dressing applied.

Post laparoscopic PD Catheter placement recovery

Immediate Postoperative

• No more than mild pain or discomfort in the abdominal area or regarding gas.
• Monitored patient a few hours.
• Catheter kept dry and clean.

First 1–2 Weeks

• Do not bend, lift or strain.
• Dressings changed daily.
• Full peritoneal dialysis normally commences after 10-14 days unless urgent-start PD is needed.

Long-Term Care

• Maintain exit-site hygiene.
• Periodical catheter performance and infection monitoring.
• Blockage is avoided by proper flushing.

PD catheter placement recovery

Peritoneal dialysis catheter insertion recovery is aimed at appropriate wound healing, infection prevention and optimal catheter functioning. The majority of patients are able to heal completely in 10-14 days, at which point the catheter may be used in a normal dialysis.

Immediate Recovery (0–24 Hours)

Post-procedure monitoring

• To assess bleeding, abdominal pain or leakage.
• Vital signs monitored.
• Lightly flushed catheters to secure patency.

Pain and discomfort

• Abdominal pains are mild.
• Pain in the shoulders could be experienced (particularly following laparoscopy insertion because of CO2).

Diet and mobility

• Liquids first, followed by normal diet.
• Light walking induced after several hours.

Early Recovery (First Week)

Wound and exit-site care

• Always dry and clean dressings.
• No showering until 48-72 hours unless recommended.
• Do not handle the exit site unnecessarily.
• The first few days are usually the period when dressing is done by trained personnel.

Activity restrictions

• No heavy lifting, strain when bending, coughing, or constipation.
• Prevent catheter area pressure.

Prevention of dialysate leakage

• Full-volume dialysis is not recommended at the beginning.
• The flushes of low volume can be performed only in a few cases (e.g., urgent-start PD).

Late Early Recovery (Days 7–14)

Catheter healing

• Incisions and exit site start healing.
• A majority of the sutures grandeur through natural dissolution.
• The treatment starts with full peritoneal dialysis that usually starts after 10-14 days.

Permission to resume operations

• Light work may resume.
• Vigorous exercise should be avoided until fully healed.

Complications inspection

Check for:

• Redness
• Swelling
• Drainage
• Persistent pain

Suboptimal dialysate inflow/outflow

Long-Term Recovery and Care

Exit-site hygiene routine

• Washing with antiseptic solution on a daily basis after healing.
• Apply dry dressing on demand.
• Do not submerge the catheter in water (do not swim).
• Training of dialysis technique

Patients are trained on:

• Bag exchanges
• Sterile technique
• It is important to note the indicators of infection.

Monitoring of catheter functioning.

• Renal blood flow and dialysate removal is smooth.
• Periodical check-ups to identify early failure.

PD catheter complications

Complications associated with the peritoneal dialysis catheters can be early or late. Such complications may affect the function of catheters, lead to infections or cause interruption of dialysis. PD therapy needs to be early diagnosed and treated.

Early Complications (Hours to Weeks After Placement)

• Dialysate Leakage
• Bleeding / Hemorrhage
• Exit-Site Infection (ESI)
• Tunnel Infection
• Peritonitis
• Pain
• Catheter Malfunction (Early Obstruction)

Late Complications (Months to Years After Placement)

• Catheter Migration
• Catheter Blockage
• Recurrent Exit-Site or Tunnel Infections
• Peritonitis (Recurrent)
• Hernias
• Dialysate Leaks (Late)
• Encapsulating Peritoneal Sclerosis

Best hospital for PD catheter placement India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

The placement of the peritoneal dialysis catheter is an important procedure in chronic dialysis patients as it enables provision of secure, effective, and home-based dialysis solutions to hemodialysis. The purpose of the insertion is to position the catheter into the peritoneal cavity properly either by laparoscopy, percutaneous, or open method, so that fluid exchange is assured. Laparoscopic placement is the better option with the advantage of better visualization, options of treating adhesions or hernias during the same procedure and reduced instances of mechanical complications. The recovery process usually goes smoothly provided the patient is adherent to wound-care instructions, does not become prematurely strained, and practices exit-site hygiene. The vast majority of the catheters are prepared to undergo full dialysis within 10-14 days. Prevention of such complications as peritonitis or tunnel infections depends on the maintenance of sterile technique, adequate training of the personnel and follow- up.

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FAQ

Does it hurt to have the catheter placed?

• No. The procedure may be performed with local anaesthesia and sedation or with general anaesthesia. You can expect mild discomfort after the surgery.

How long after catheter placement can I do peritoneal dialysis?

• Majority of patients are allowed full PD at 10–14 days to heal adequately. Urgent-start PD may begin earlier at the time of catheter placement with low-volume exchanges.

What should I not do after the surgery?

• Do not lift heavy objects, strain, bend or exercise vigorously for the first 2 to 3 weeks after your procedure to prevent leaking or moving of the catheter.

What does it mean if the dialysis fluid is cloudy?

• Cloudy fluid is the classic symptom of peritonitis and should be evaluated by a doctor immediately.

Can the catheter be removed if it doesn’t work right?

• Yes. The repositioning of the catheter can be performed either by fluoroscopy or via laparoscopy.

How long does a PD catheter last?

• With good maintenance, a catheter may last for years, but in rare cases it may need to be replaced.

Can I shower or swim with a PD catheter?

• You can shower 3-5 days after surgery when the wound has healed (and is covered). We don’t recommend swimming or bathing in pools or the ocean due to the potential risk of infection.

Will a catheter interfere with my day-to-day life?

• When they are healed, most people can live normal day-to-day lives. When the catheter is properly secured, it will not cause discomfort or be accidentally yanked.