Peritoneal Dialysis Catheter Placement Techniques

Abstract

The success of catheter placement is critically important for the ability to stay on peritoneal dialysis over the long-term. Nephrologists have used percutaneous placement with or without fluoroscopic guidance and placement using peritoneoscopic guidance to place these catheters. Complications can be divided into early, within 14 days, and late complications, those arising more that 14 days after the procedure. The main post-procedure complications are infection, leakage, and obstruction. Results of non-invasive placement have been comparable to surgical placements. The noninvasive technique is simple with minimal intra-operative morbidity, and a post-placement complication rate better than surgical placements. Comparing percutaneously placed catheters to laparoscopically and peritoneoscopically placed catheters shows that the laparoscopic technique has a better one year survival rate. In deciding which technique is best for the patient, it is important to identify advantages of percutaneous placement, such as use of local anesthesia, lower rates of complications, the fact that it is a bedside or office procedure, versus the limitations in that the percutaneous method is not suited for obese patients or those patients likely to have peritoneal adhesions. Peritoneal catheters can be placed in a timely manner without delays associated with surgical scheduling. This offers an added option, both to the neprhologist and the patient and may avoid starting dialysis using a central venous catheter. The placement of peritoneal dialysis catheters by nephrologists has been shown to increase utilization of peritoneal dialysis as a dialysis modality, and this is an important advantage of the procedure.

An Unusual Case of Peritoneal Dialysis Twisted Catheter in a Child

“…1,3 Twisted catheter is typically associated with surgical complications during catheter insertion. 4 In our patient, the twisted catheter occurred during chronic catheter-site care. Ultrafiltration problems did not occur, and catheter malposition was ruled out by abdominal imaging.…”

A Nationwide Comparative Analysis of Peritoneoscopic and Laparoscopic Techniques for Peritoneal Dialysis Catheter Insertion in Brunei Darussalam

“…The standard peritoneoscopic technique (Y-TEC) has been described elsewhere. 5 In both methods, patients were instructed to wash the whole body with chlorhexidine and to empty their bladder and bowel immediately prior to the procedure. Laxatives were used starting few days before the procedure to ensure patients had a bowel movement on the day of the procedure.…”

Laparoscopically assisted insertion of peritoneal dialysis catheter

“…Several authors found a benefit with laparoscopic insertion, while the others showed, they were equivalent in complications and catheter survival. [ 1 3 ] Despite different opinions of experts and different results of randomised clinical trials and meta-analyses, laparoscopic insertion of PD catheter is becoming widely accepted method for gaining of peritoneal access.…”