Laparoscopic Peritoneal Dialysis Catheter Placement

What is peritoneal dialysis?

Laparoscopic Peritoneal Dialysis Catheter Placement

The kidneys are two bean-shaped organs that help filter the blood of waste. Kidney failure can occur when the kidneys fail to perform this function. Peritoneal dialysis (PD) is a procedure that is used to remove excess fluid and waste products from the blood when the kidneys can no longer function. It is a widely-accepted method of home dialysis that eliminates the need to visit the dialysis center for hemodialysis (a blood-filtering procedure using a machine) three times a week for about 3-5 hours each visit.

Peritoneal dialysis is a flexible method that can be performed at home, at work or while traveling.

What are the indications of peritoneal dialysis?

Peritoneal dialysis is indicated for the following:

  • Infants and young children
  • Difficulty in accessing veins for treatment
  • Hemodynamic instability: a state requiring external support to maintain normal blood pressure
  • Distance from dialysis center
  • Need for independence, frequent travel and varying schedules
  • Diseases like hypertension, cardiovascular diseases, HIV, hepatitis B or C, or bleeding problems
  • Candidate for transplantation

However, peritoneal dialysis may not be recommended for the following:

  • Third-trimester pregnancy
  • Elderly
  • Poor hygiene
  • Severe malnutrition
  • Conditions such as severe obstructive lung disease, abdominal adhesions (scar tissue) or proteinuria (abnormal amounts of protein in urine)

How does peritoneal dialysis work?

Peritoneal dialysis uses a thin membrane called the peritoneal membrane that lines the abdomen to perform the dialysis. A small, flexible tube called the peritoneal dialysis catheter (PD catheter), is inserted into the abdomen to carry out the procedure. The procedure involves three steps:

  • Filling the abdomen with the dialysis solution (dialysate) containing dextrose sugar that acts as an osmotic agent
  • Leaving the dialysis solution for a few hours (dwell time) so that the waste products and extra fluid pass from the blood into the dialysis solution through the peritoneal membrane, while RBCs and nutrients are retained
  • Draining the dialysis solution containing the waste and extra fluid and replacing it with fresh dialysis fluid

The dwell time is around 4-6 hours and the drain and fill time, about 30-40 minutes with 4-5 exchanges a day.

How is a peritoneal dialysis catheter placed?

A peritoneal dialysis catheter is also placed under general anaesthesia. A small incision is placed (usually around the belly button) and a camera is inserted into the abdominal cavity. A brief exploration is performed and the catheter is placed using an additional two to three tiny incisions in your skin. Sometimes after we look around with a camera, we are unable to place the catheter most often due to scar tissue. That is why if a patient has had multiple abdominal surgeries, it may be impossible to place a peritoneal dialysis catheter.

What can you expect after a laparoscopic peritoneal dialysis catheter placement?

Common post-operative guidelines following laparoscopic peritoneal dialysis catheter placement include the following:

  • The dressing at the exit site has to be kept intact for one week / several days unless there is leakage or bleeding at the exit site.
  • The dressing will be changed initially by nurses
  • The exit site has to be kept dry and covered with a clean gauze and tape.
  • Avoid showers for the first several weeks.

Are there any complications of a laparoscopic peritoneal dialysis catheter placement?

    As with any procedure, laparoscopic peritoneal dialysis catheter placement involves certain risks and complications. They include, but are not limited to:

  • Intestinal perforation when the peritoneal catheter is inserted into the abdominal cavity, causing symptoms of pain, nausea or a rigid abdomen
  • Failure of the catheter, due to blockages caused by adhesions or debris
  • Leakage of dialysate (the fluid used for dialysis) from the peritoneal catheter
  • Pain or discomfort in cases where the dialysate is too acidic, extremely cold or infused swiftly through the peritoneal catheter
  • Death

Some of the complications, such as infection of the tunnel and exit-site, problems with dialysate drainage or hernias, may occur after a month of catheter insertion. However, under a skilled specialist, laparoscopic peritoneal dialysis catheter placement can be performed safely.

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