Patient education: Peritoneal dialysis catheter placement (The Basics)

What is peritoneal dialysis? — Peritoneal dialysis, or "PD," is a treatment for kidney failure. Normally, the kidneys work to filter blood and remove waste and excess salt and water. Kidney failure, also called "end-stage kidney disease," is when the kidneys can no longer filter blood properly.

PD involves piping a special fluid into the belly (figure 1). This fluid collects waste and excess salt and water from the blood. Then, the used fluid drains out of the belly.

What is a PD catheter? — A PD catheter is a thin, flexible tube used to get the fluid in and out of the belly for dialysis (figure 2). One end of the tube stays in the belly. The other end stays outside of the body. There are often 1 or 2 "cuffs" under the skin to help hold the PD catheter in place.

After getting a catheter placed, it usually takes about 2 weeks for the body to heal. Your doctor will talk to you about when you can start dialysis.

How is a PD catheter placed? — Before you start PD, you need surgery to place a PD catheter.

The PD catheter can be placed in 3 ways:

●Open surgery – During an open surgery, the doctor makes a cut, or "incision," in the skin. This lets them see directly inside the body when they do the surgery.

●Minimally invasive surgery – "Minimally invasive" surgery lets the doctor make smaller cuts in the skin. They insert long, thin tools through the cuts. One of the tools has a camera (called a "laparoscope") on the end, which sends pictures to a TV screen. The doctor can look at the screen to see inside the body. Then, they use the long tools to do the surgery.

●Percutaneous procedure – For percutaneous procedures, the doctor inserts a special tool through the skin. This might be done by a surgeon or another doctor called an "interventionalist."

You might be able to return to normal activities sooner if you had minimally invasive surgery or a percutaneous procedure than if you had open surgery.

How do I prepare for PD catheter placement? — The doctor or nurse will tell you if you need to do anything special to prepare.

●You might need to take stool softeners or laxatives to clean out your bowels.

●The doctor might want you to stop taking calcium or iron supplements for a time before the PD catheter is placed. If so, they will tell you when it is safe to restart them after your procedure.

Before your procedure, your doctor will do an exam to help determine where to place the PD catheter. The doctor might ask you:

●What position you sleep in most often – For example, if you usually sleep on your left side, it would be better to place the PD catheter on your right side.

●If you are left- or right-handed – It can be easier to take care of the PD catheter if it is on the side of your dominant hand.

●Where your belt or pants lie on your body when you are standing, sitting, and lying down – They will place the PD catheter away from this area and any skin folds.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before your procedure – In some cases, you might need to "fast" before surgery. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●Lowering the risk of infection – In some cases, you might need to trim (not shave) your body hair before your procedure. You might also need to wash the area with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during PD catheter placement? — When it is time for the procedure:

●You might get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Types of anesthesia include:

•Local – This type of anesthesia is sometimes used for a percutaneous procedure. It uses medicine to numb a small part of your body so you don't feel pain. You might also get medicines to make you relax and feel sleepy, called "sedatives."

•Regional – This type of anesthesia blocks pain in 1 area of your body, such as an arm, a leg, or the lower half of your body. If you get regional anesthesia, you might be awake. Or you might get medicines to make you relax and feel sleepy, called "sedatives."

•General – This type of anesthesia is used for open and minimally invasive PD catheter placement. It makes you unconscious so you can't feel, see, or hear anything during the procedure. If you have general anesthesia, you might get a breathing tube to help you breathe.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●A PD catheter is placed through the skin and into the belly. It is "tunneled" under the skin:

•For a percutaneous procedure, the doctor will often use ultrasound or fluoroscopy (a continuous type of X-ray). This helps them guide 1 end of the catheter into the right place inside the belly. For open or minimally invasive surgery, the doctor will be able to see the catheter and place it in the right area.

•Once the catheter is in the right place, the doctor will make a small incision in your skin. They will tunnel the other end of the catheter through muscle and fat, and out through the incision.

•Most of the time, the catheter exits the skin to the left or right of the belly button. Sometimes, the doctor will have the catheter exit the skin higher up.

●When the procedure is done, the doctor will place a metal "adapter cap" on the end of the catheter. To make sure that the catheter is working properly, they will use it to fill the belly with sterile fluid and let it drain out.

●The doctor or nurse will place a special bandage over the catheter. This keeps it from moving, keeps it clean, and helps prevent infection.

●The procedure usually takes about an hour.

What happens after PD catheter placement? — The doctor might order an X-ray to make sure that the tip of the catheter is in the right place before it is used.

If you need dialysis urgently, you might be able to start it a few days after surgery with small amounts of fluid. In most cases, the doctor will wait a couple of weeks before using the PD catheter for dialysis.

What are the risks of PD catheter placement? — Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Infection

●The catheter not working

●Injury to organs in your belly

What else should I know? — If you are going home with a PD catheter, you might need a family member or friend to help you care for it. Some people have a home health nurse come to their home to help with this.

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