Make a Plan: PD Catheter, Fistula and Graft Surgeries

Depending on which form of dialysis you choose, you will have to undergo either peritoneal dialysis (PD) catheter placement or vascular access surgery. Before making a decision about the type of dialysis you will do, it is important that you become knowledgeable about your choices. Speak with your nephrologist, and meet with a dialysis educator, read and watch educational materials and even visit a dialysis center. Although some patients change the type of dialysis they do over time, this initial choice is an important one. It is best when this decision is made well in advance of needing to start dialysis, because both surgeries require proper planning.

PD catheter placement

If you choose PD, your doctor will examine you and check for any problems you may have with your abdomen.

Prior to  PD catheter surgery, it’s important that you meet with your PD nurse to plan your catheter placement and arrange for follow-up. Your PD nurse will give you clear instructions about what to do before and after surgery. In most cases, you’ll be asked to return and visit the nurse a few days after your operation.

PD catheter placement is usually done under general anesthesia, but most patients are able to go home the day of the procedure.

A PD catheter is a soft, flexible plastic tube about the length of a ruler and the width of a pencil. During surgery, one end of the catheter will be put into your peritoneal cavity. The rest of the catheter will come through your lower abdomen, underneath and to the side of your belly button. This tiny hole, where the catheter comes out of your body, is called the exit site.

There are two common ways of placing a catheter: laparoscopic and surgical.

  1. Laparoscopic
    Laparoscopic uses general anesthesia and requires that two small incisions be made in the abdomen: one for the surgeon to see  inside the peritoneal cavity and the second for the catheter itself.
  2. Surgical
    The patient is given general anesthesia and the surgeon makes an incision through the abdominal wall into the peritoneum and then places the catheter through that incision into the proper position. The catheter is then tunneled through the abdominal wall until it exits in the appropriate location.

A transfer set will be placed onto your catheter by the surgeon during surgery. A transfer set is a 4- to 6-inch piece of tube with a valve on the end that is used to open and close your catheter during the exchange process. To avoid infection, it is best to have a transfer set put on during your operation.

Fistula placement for hemodialysis

An arteriovenous (AV) fistula is created by connecting one of your arteries to one of your veins using your own vessels. It is best if the decision to have the fistula surgery is made well before you need dialysis. This is because once the fistula is created, it takes approximately three to six months for the fistula to “mature” enough to use. Doctors prefer fistulas because they provide good blood flow and generally last longer than other types of access. Because a fistula is created from your artery and vein, it is a natural part of your body.

Before your fistula surgery, you may undergo a test to determine whether your veins are large enough for a fistula. Fistula placement is generally performed as an outpatient operation. Your doctor will usually sedate you and numb the area where the fistula will go, but you may be put to sleep by an anesthesiologist.

After surgery, your doctor may advise you to keep the fistula area elevated to reduce swelling. He or she may also prescribe pain medication. To strengthen your fistula, you can do exercises such as squeezing a rubber ball.

Graft placement for hemodialysis

If your veins are too small for a fistula or your veins are blocked, your doctor may suggest an arteriovenous (AV) graft. A graft is a man-made tube that is inserted into your arm to connect an artery to a vein.

Grafts can usually be used for dialysis within two to six weeks. However, your doctor may suggest waiting four to six weeks to ensure your graft is fully healed.

Get more information

The type of access surgery you undergo depends on the dialysis treatment. Talk with your about treatment options or take the Treatment Evaluator quiz.

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