Laparoscopic Peritoneal Dialysis Catheter Placement
What is peritoneal dialysis?
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
- 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
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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