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Peritoneal dialysis catheter insertion
This leaflet provides information on having a peritoneal dialysis (PD) catheter inserted. Please read it as well as talking to your doctor.
What is a peritoneal dialysis (PD) catheter and why is it inserted?
A PD catheter is a small plastic tube inserted into the part of your abdomen called the peritoneal cavity. It is used for peritoneal dialysis which is a process of removing excess fluid and waste products from your body by running fluids in and out through the PD catheter. It is one of the treatments used in kidney failure that allows you to carry out your own treatment at home without having to come to the hospital on a regular basis.
Who does the procedure?
The procedure can be done either by a kidney doctor under local anaesthetic (medical PD catheter insertion) or by a surgeon in theatre under sedation or general anaesthesia. The options will be discussed with you beforehand. The choice depends in part on whether you have already had any surgery or problems with your tummy.
How long does it take?
The procedure itself takes about 45 minutes to an hour to complete.
Before the procedure
A specialist nurse or doctor will assess you in clinic to ensure you are fit for the procedure. You will need blood tests and swabs. Your medications will be reviewed and some, like blood thinners, may need to be paused pre-procedure. You may be required to come into the hospital the day before the PD catheter insertion to start antiseptic showers, prophylactic antibiotic treatment, and bladder and bowel preparation. Instructions about when to fast from food and drink will also be provided. You will need to sign a consent form for the procedure.
During the procedure
Medical PD catheter insertion
Your abdomen will be cleaned with an antiseptic solution and covered with a drape. Local anaesthetic will be given to make sure that you do not feel any pain. A small incision about 2-3 cm will be made just below your belly button through which the PD catheter will be inserted. This should not be painful, but you may feel some pushing and other peculiar sensations in your tummy as the catheter is being put in.
When the catheter is in position, a small amount of fluid will be flushed through it to ensure the PD fluid is able to run in and out through it easily. Another incision about 0.5cm long will be made at the side of your abdomen a few centimetres away from the first incision where the catheter will exit the skin.
At the end of the procedure, the incisions will be closed with stitches, your catheter exit site will be covered with a dressing and you will be transferred back to the ward.
Surgical PD insertion
- Keyhole surgery: Two to three small cuts will be made on your tummy. The surgeon will then use a laparoscopic camera (small camera at the end of a thin tube) to look inside your tummy and help place the PD catheter.
- Mini laparotomy: A small cut will be made 4-5 cm below your belly button where the surgeon will insert the catheter into your peritoneal cavity.
In both surgical procedures, fluid will be flushed in and out of your tummy through the catheter then dressings will be applied. You will need to stay in the recovery unit for around three to four hours.
After the procedure
- Your new PD catheter will be flushed on the ward to ensure it is fully open, your observations will be closely monitored, and you should be able to go home after a few hours unless you are asked to stay in.
What are the risks of a dialysis line insertion?
- Pain: you may experience some discomfort and pain after the procedure; you will be given analgesics for this.
- Infection: there is a risk of infection either in the peritoneal cavity or around the catheter exit site; this is usually treated with antibiotics.
- Bleeding and leakage: these are both rare and may occur at the operation site.
- Malfunction: the catheter can move inside the peritoneal cavity and this can affect the fluid drainage. If this happens, you may need another operation to reposition it.
- Injury to other organs: this is a rare complication; the PD catheter may accidentally puncture the wall of your bowel and/or urinary bladder during insertion. If this happens, you may need to have an operation to repair any damage.
- Contact the home therapies unit or go to the emergency department if you notice any signs of excessive wound bleed/leak or pus on the dressing, prolonged or severe pain around the catheter exit site, any unusual lumps or swelling under the skin near the catheter, or signs of infection such as fever, chills and feeling sick.
How to take care of your PD catheter
- Please leave your dressing in place until it is changed on your first appointment at the renal unit.
- Do not shower or have baths until you have seen the PD nurses in clinic, and they advise you to do so.
- Do not use scissors or any other sharp object near your catheter for any reason. Your catheter is precious and should not be damaged.
- PD increases the chance of you becoming constipated. It is very important that you continue your prescribed laxatives to ensure the PD catheter works properly.
- The PD nurses will teach you how to inspect your catheter exit site and change your dressing as part of your daily catheter care routine.
- You will be given dates for your dialysis training and a nurse will visit your home when you do your first dialysis to ensure you are safe and confident in doing your own dialysis.
- Driving: You should not drive for five days after laparoscopic PD insertion, seven days after a medical insertion and 14 days after Mini laparotomy. You may need to check with your insurance company when you can drive. One indicator to tell you can drive safely is if you are able to perform an emergency stop comfortably. You can try this while the car is parked. If it hurts, leave it for two more days and try again.
- Do not lift any heavy items until you start your treatment and discuss with the PD team.
- You will be assigned a named nurse who will support you through your PD treatment.
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