Preparing for Peritoneal Dialysis Catheter Surgery 

By Mark H. Shapiro, MD

Disclaimer: This article is for informational purposes only and is not intended to be a substitute for medical advice or diagnosis from a physician.

Peritoneal dialysis (PD) is an excellent form of therapy for many patients with kidney failure. It’s estimated that up to 80 percent of patients are capable of doing PD, and it may be a better form of dialysis therapy for 25-30 percent of people requiring dialysis. With the help of your nephrologist, close family members and a variety of materials both in print and online, you can determine whether this home dialysis treatment option is right for your lifestyle.

In order to perform PD, you will need to have a PD catheter placed into your abdomen. A PD catheter is a flexible plastic tube that allows dialysis fluid to enter the abdominal cavity, dwell inside for a while, and then drain back out again. There are several different designs and manufacturers, but there is no evidence that one type of catheter works better than another.

PD catheter placement is considered a minor operation, and complications are rare. It often requires general anesthesia, but the whole procedure takes less than one hour of surgical time. Most catheters have two Dacron cuffs that remain inside the abdominal wall to keep it in place. Typically, a surgeon at a hospital will perform the procedure. However, there are some nephrologists and radiologists who are also trained to place PD catheters.

In general, it is best to have the catheter placed at least two weeks before actually beginning PD. In some cases, PD may start within a few days of having the catheter placed. Using the catheter early may increase the risk of having a leak, which is the most common complication after surgery.

What to expect when a PD catheter is placed

The following is generally what you can expect when undergoing PD catheter surgery, but also ask your physician about what the process may be like for your individual case.

  1. Once you and your nephrologist decide that PD is right for you, you’ll visit the PD program team at your local DaVita dialysis center to meet with the PD nurse and receive education and instructions about the PD catheter placement process.
  2. You’ll be referred to a surgeon who will then schedule the procedure.
  3. One to two days before surgery, you should visit with the PD nurse again for additional instructions regarding your surgery. The PD nurse may make recommendations for the surgeon about where on the abdomen to place the exit site. If so, your nurse will document the site and any measurements so that you can bring it with you to surgery. Also on the day prior to surgery, you can participate in all your normal activities. However, you are not allowed to eat or drink anything after midnight and should make an effort to get a good night of sleep. You will come to the surgical center the next morning with an empty stomach and generally should not take any medications unless instructed to. People who use insulin are often told to give themselves only half of their usual dose since they won’t be eating until after surgery.
  4. You will check into the surgical area and be asked to fill out some paper work. When that is completed, you will change into a surgical gown and be asked to lie down on a gurney. Someone will shave any hair off your abdomen and then clean it with some surgical soap. An intravenous line will be placed into your arm, and an anesthesiologist will meet with you and discuss the procedure. Anesthesia will be administered through your IV, and you will sleep until the procedure is completed.
  5. The surgeon will place the PD catheter into the abdomen, most likely laparoscopically, or with minimally invasive surgery (MIS). In most cases it can be done without hospital admission, and the patient goes home the same day with a prescription for pain medications (which are sometimes needed for a few days).

What to expect after a PD catheter is placed 

  1. You’ll go home with the PD catheter taped to the outside of your abdomen and covered with a dressing. The dressings are left alone and should not be changed by you or family members. It’s important that the dressing is kept dry, which means no showers or baths for 7-10 days.
  2. During the 7-10 day period after surgery, there may be mild discomfort. Patients should avoid heavy lifting and exercises such as sit-ups for the entire time. However, you can resume other activities generally after 3-4 days.
  3. You will return to the PD clinic 7-10 days after surgery to see the PD nurse, who will change the dressings and clean the catheter exit site. The nurse will also flush the catheter with dialysis solution, and start your initial training to perform PD at home.

Summary

PD catheter surgery is a minor operation, but it’s still important to know what to expect before having this procedure. After the catheter is placed, the primary goals are to keep the exit site clean and prevent the catheter from pulling on the exit site. A PD catheter, when placed properly, shouldn’t interfere with most everyday activities. PD catheters that are properly cared for can often be used without problems for many years. Learning everything there is to know about PD—including PD catheter placement—can help you succeed on this type of home dialysis treatment.

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About Mark H. Shapiro, M.D. 

Dr. Shapiro is a nephrologist who practices in Escondido, Calif. He did his undergraduate training at University of California, Los Angeles, obtained his medical degree at the University of Pittsburgh, and completed his residency training and nephrology fellowship at the University of California, San Diego.

Dr. Shapiro is an Assistant Professor of Medicine at University of California, San Diego, and also maintains an active private nephrology practice in the San Diego area. His primary area of medical interest is in peritoneal dialysis (PD). Dr. Shapiro was a medical advisor for PD within Gambro Healthcare, Inc., and more recently was named the national peritoneal dialysis medical advisor within DaVita Inc. In addition, he serves on the Physician Advisory Council and the Pharmacy and Therapeutics Committee within DaVita.

Dr. Shapiro is married and has two sons. He enjoys kayaking, fishing and most other outdoor sports.


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