Vascular: Peritoneal Dialysis (PD) Catheterization

Peritoneal Dialysis (PD) Catheter

Placement

  • Placed in Lower Peritoneum/Pelvis
    • Males: Rectovesical Pouch
    • Females: Rectouterine Pouch
  • Cuff Placement
    • Deep Cuff: In Muscle
    • Superficial Cuff: 2-4 cm From Exit Site
  • Only Absolute Contraindication: Lack of a Peritoneal Membrane

Concomitant Hernia

  • Increased Intraabdominal Pressure During Dialysis Risks Worsening Hernia & Incarceration
  • Should Repair Simultaneously
  • Large Hernias are Not Necessarily Contraindications – Less Likely to Incarcerate than Smaller Hernias

Time to Use

  • No Hernia Repair: 1-2 Weeks
  • With Hernia Repair: 4-6 Weeks (Allow Hernia to Heal)

Basic Use

  • Modalities:
    • Continuous Ambulatory Peritoneal Dialysis (CAPD) – Multiple Daily & One Nightly Exchange
    • Automated Peritoneal Dialysis (APD) – Multiple Short Nightly Exchanges
      • Continuous Cycler Peritoneal Dialysis (CCPD) – Multiple Nightly Exchanges & A Long Day-Time Dwell
      • Nightly Intermittent Peritoneal Dialysis (NIPD) – Multiple Nightly Exchanges without A Day-Time Dwell
      • Intermittent Peritoneal Dialysis (IPD) – Multiple Short Exchanges Performed Intermittently (Not for Chronic Use)
  • Concepts:
    • Dialysate – Fluid Circulated into the Abdominal Cavity to Absorb Waste
    • Dwell Time – Period of Time that Dialysate Stays in the Abdomen
      • Typically 4-6 Hours
    • Exchange – Draining of Dwelling Dialysate for New Dialysate
      • Often Takes 30-40 Minutes

Complications

  • Bacterial Peritonitis
  • Surgical Site Infection
    • Presentation: Purulent Drainage from Exit-Site & Severe Erythema
    • Treatment: Antibiotics
  • Hernia
    • From Metabolic & Hydrostatic Forces
    • Treatment: Elective Repair (Leave Catheter)
  • Outflow Failure
    • Most Common Cause: Constipation
  • Catheter Tip Migration/Displacement
    • Presentation: Dialysis Failure
    • Diagnosis: Plain Abdominal X-Ray
      • Look for Position, Kinking or Significant Stool Burden
    • Treatment: Catheter Repositioning
      • Nonoperative Manipulation: Fogarty Catheter, Foley Catheter Stylet or Guidewire
      • Operative Manipulation: Laparoscopic or Open
        • 85-90% Require Surgical Revision

PD Catheter Kit 1

Port Placement and Catheter Insertion Sites 1

Catheter Tunneling and Placement 1

Appropriate Positioning in the Pelvic Cul-de-Sac 1

PD Catheter 2

References

  1. Haggerty SP, Zeni TM, Carder M, Frantzides CT. Laparoscopic peritoneal dialysis catheter insertion using a Quinton percutaneous insertion kit. JSLS. 2007 Apr-Jun;11(2):208-14. (License: CC BY-NC-ND-3.0)
  2. Swarnalatha G, Rapur R, Pai S, Dakshinamurty KV. Strangulated umbilical hernia in a peritoneal dialysis patient. Indian J Nephrol. 2012 Sep;22(5):381-4. (License: CC BY-NC-SA-3.0)