Peritoneal Dialysis Catheter Placement and Management

Abstract

Additional information is available at the end of the chapter http://dx.doi.org/10.5772/56596 . IntroductionPeritoneal dialysis PD is an alternative to hemodialysis in patients with end-stage renal disease ESRD . The main function of a peritoneal dialysis catheter is to permit consistent bidirectional flow of dialysate into intraabdominal peritoneal cavity without obstruction or undue discomfort [ ]. Most catheters are flexible tubes with multiple ports in the intraabdominal segment which is ideally positioned freely in the intraabdominal pelvic area. The catheter's function depends upon its design, implantation site, and the configuration of the system used to perform dialysis exchanges, and also be directly related to skill of catheter placement doctors, catheter-related problems and infections are responsible for approximately % of implantation technique failure [ ]. contents of this chapter are types of catheters, considerations in catheter placement, exit site location, exit site size, antibiotic prophylaxis, implantation technique, postoperative catheter care, exit site care, complication, repositioning migrated peritoneal dialysis catheters, brief information for patients, recommendations. . . Types of cathetersMany types of catheters are currently available for chronic peritoneal dialysis Figure . Peritoneal catheters have intraperitoneal and extraperitoneal segments. The extraperitoneal segment passes through a tunnel within the abdominal wall, exits through the skin, and has an external segment. Most catheters are flexible tubes with multiple ports in the distal intraperitoneal segment. The intraperitoneal portion of the catheter should be ideally placed between the visceral and parietal peritoneum near the pouch of Douglas. The catheter's midportion is normally implanted within the wall of the abdomen by one to two Dacron velour cuffs. With double-cuffed catheters, the inner cuff should be imbedded in the abdominal rectus muscle to prevent leaks the superficial cuff in both double cuff and single cuff catheters should

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“…Extended periods of immobilization or non-ambulation can lead to catheter migration, which may require surgical repositioning. 37) Therefore, efforts should be made to encourage ambulation and minimize immobilization after surgery to support successful PD.…”