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Peritoneal Dialysis Catheter Placement
Keith B. Quencer, MD
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KEY FACTS

  • Preprocedure

    • Procedure

      • Post Procedure

        • Outcomes

          TERMINOLOGY

          • Abbreviations

            • Peritoneal dialysis (PD)
          • Definitions

            • Mechanism of action
              • Movement of solutes and water between 2 compartments across semipermeable membrane (peritoneal lining)
                • Surface area of peritoneal membrane is 1-2 m²
                • 1 compartment is peritoneal capillary bed
                  • High concentration of uremic toxins
                  • Blood flow via inferior epigastric, intercostal, and lumbar arteries
                • Other component is peritoneal cavity
                  • Where PD solution (dialysate) is infused
              • Solutes
                • Move down concentration gradients via diffusion
                  • Urea and potassium move from high concentration in peritoneal capillary bed to low concentration dialysate in peritoneal cavity
                • Moved via convection (a.k.a. solute drag)
                  • Movement of solutes with water (small proteins)
              • Water
                • Moves across membrane in response to osmotic/colloid gradient force
                  • Dialysate hypertonic/hypercolloid
                  • Pulls water from peritoneal capillary bed to peritoneum
            • Utilization
              • PD utilized as renal replacement therapy (RRT) in ~ 200,000 end-stage renal disease (ESRD) patients
              • 9.5% of patients in USA; 11% of patients worldwide
            • Advantages c/w hemodialysis (HD)
              • Lower cost
              • Fewer hospitalizations
              • Lower need for interventions to maintain access
              • Greater patient independence
                • Greater autonomy of care
              • Lower potential for infectious disease outbreak c/w HD
                • HIV/hepatitis outbreaks at HD centers
              • No need for subsequent needle sticks after placement
              • Survival advantage
                • Better preservation of residual kidney function
                  • Preservation of endocrine and metabolic function
                  • Some residual kidney function preserves Na+ and water clearance
                • No access-related heart failure
                • No hypotension during HD (intradialytic hypotension)
                  • Can cause myocardial stunning
              • Better lifestyle
                • No need for frequent travel to HD center
                • Less prohibitive dietary considerations
                • Can travel/vacation more easily

          PREPROCEDURE

          • Indications

            • Contraindications

              • Preprocedure Imaging

                • Getting Started

                  PROCEDURE

                  • Patient Position/Location

                    • Procedure Steps

                      • Alternative Procedures/Therapies

                        POST PROCEDURE

                        • Things to Do

                          • Things to Avoid

                            OUTCOMES

                            • Problems

                              • Complications

                                • Expected Outcomes

                                  Selected References

                                  1. Esagian SM et al: Surgical versus percutaneous catheter placement for peritoneal dialysis: an updated systematic review and meta-analysis. J Nephrol. 34(5):1681-96, 2021
                                  2. Ma Y et al: Association between different peritoneal dialysis catheter placement methods and short-term postoperative complications. BMC Nephrol. 22(1):151, 2021
                                  3. Zang Z et al: Different techniques for peritoneal dialysis catheter implantation: a systematic review and network meta-analysis. Perit Dial Int. 41(6):522-32, 2021
                                  4. Zou Y et al: Assessment of complications and short-term outcomes of percutaneous peritoneal dialysis catheter insertion by conventional or modified Seldinger technique. Ren Fail. 43(1):919-25, 2021
                                  5. Morris CS: Interventional radiology placement and management of tunneled peritoneal dialysis catheters: a pictorial review. Radiographics. 40(6):1789-806, 2020
                                  6. Crabtree JH et al: Creating and maintaining optimal peritoneal dialysis access in the adult patient: 2019 update. Perit Dial Int. 39(5):414-36, 2019
                                  7. Tanasiychuk T et al: The ideal position of the peritoneal dialysis catheter is not always ideal. Int Urol Nephrol. 51(10):1867-72, 2019
                                  8. Lee J et al: Radiological Tenckhoff catheter insertion for peritoneal dialysis: a cost-effective approach. J Med Imaging Radiat Oncol. 62(2):174-8, 2018
                                  9. Crabtree JH et al: Peritoneal dialysis catheter insertion. Semin Nephrol. 37(1):17-29, 2017
                                  10. Crabtree JH: Peritoneal dialysis catheter implantation: avoiding problems and optimizing outcomes. Semin Dial. 28(1):12-5, 2015
                                  11. Gallieni M et al: Type of peritoneal dialysis catheter and outcomes. J Vasc Access. 16 Suppl 9:S68-72, 2015
                                  12. Abdel-Aal AK et al: Best practices consensus protocol for peritoneal dialysis catheter placement by interventional radiologists. Perit Dial Int. 34(5):481-93, 2014
                                  13. Bagul A et al: Laparoscopic peritoneal dialysis catheter (PDC) insertion: does it really make a difference? J Nephrol. 27(2):127-34, 2014
                                  14. Kuru S et al: Sclerosing encapsulating peritonitis with perforation of the gastrointestinal tract: a serious complication of continuous peritoneal dialysis. Ann Saudi Med. 32(6):660-1, 2012
                                  15. Singh SK et al: Peritoneal dialysis catheter malfunction because of encasement by an extraluminal fibrin sheath. Perit Dial Int. 32(2):218-20, 2012
                                  16. Dell'Aquila R et al: Rational choice of peritoneal dialysis catheter. Perit Dial Int. 27 Suppl 2:S119-25, 2007
                                  17. Rabindranath KS et al: Automated vs continuous ambulatory peritoneal dialysis: a systematic review of randomized controlled trials. Nephrol Dial Transplant. 22(10):2991-8, 2007
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Preprocedure

                                    • Procedure

                                      • Post Procedure

                                        • Outcomes

                                          TERMINOLOGY

                                          • Abbreviations

                                            • Peritoneal dialysis (PD)
                                          • Definitions

                                            • Mechanism of action
                                              • Movement of solutes and water between 2 compartments across semipermeable membrane (peritoneal lining)
                                                • Surface area of peritoneal membrane is 1-2 m²
                                                • 1 compartment is peritoneal capillary bed
                                                  • High concentration of uremic toxins
                                                  • Blood flow via inferior epigastric, intercostal, and lumbar arteries
                                                • Other component is peritoneal cavity
                                                  • Where PD solution (dialysate) is infused
                                              • Solutes
                                                • Move down concentration gradients via diffusion
                                                  • Urea and potassium move from high concentration in peritoneal capillary bed to low concentration dialysate in peritoneal cavity
                                                • Moved via convection (a.k.a. solute drag)
                                                  • Movement of solutes with water (small proteins)
                                              • Water
                                                • Moves across membrane in response to osmotic/colloid gradient force
                                                  • Dialysate hypertonic/hypercolloid
                                                  • Pulls water from peritoneal capillary bed to peritoneum
                                            • Utilization
                                              • PD utilized as renal replacement therapy (RRT) in ~ 200,000 end-stage renal disease (ESRD) patients
                                              • 9.5% of patients in USA; 11% of patients worldwide
                                            • Advantages c/w hemodialysis (HD)
                                              • Lower cost
                                              • Fewer hospitalizations
                                              • Lower need for interventions to maintain access
                                              • Greater patient independence
                                                • Greater autonomy of care
                                              • Lower potential for infectious disease outbreak c/w HD
                                                • HIV/hepatitis outbreaks at HD centers
                                              • No need for subsequent needle sticks after placement
                                              • Survival advantage
                                                • Better preservation of residual kidney function
                                                  • Preservation of endocrine and metabolic function
                                                  • Some residual kidney function preserves Na+ and water clearance
                                                • No access-related heart failure
                                                • No hypotension during HD (intradialytic hypotension)
                                                  • Can cause myocardial stunning
                                              • Better lifestyle
                                                • No need for frequent travel to HD center
                                                • Less prohibitive dietary considerations
                                                • Can travel/vacation more easily

                                          PREPROCEDURE

                                          • Indications

                                            • Contraindications

                                              • Preprocedure Imaging

                                                • Getting Started

                                                  PROCEDURE

                                                  • Patient Position/Location

                                                    • Procedure Steps

                                                      • Alternative Procedures/Therapies

                                                        POST PROCEDURE

                                                        • Things to Do

                                                          • Things to Avoid

                                                            OUTCOMES

                                                            • Problems

                                                              • Complications

                                                                • Expected Outcomes

                                                                  Selected References

                                                                  1. Esagian SM et al: Surgical versus percutaneous catheter placement for peritoneal dialysis: an updated systematic review and meta-analysis. J Nephrol. 34(5):1681-96, 2021
                                                                  2. Ma Y et al: Association between different peritoneal dialysis catheter placement methods and short-term postoperative complications. BMC Nephrol. 22(1):151, 2021
                                                                  3. Zang Z et al: Different techniques for peritoneal dialysis catheter implantation: a systematic review and network meta-analysis. Perit Dial Int. 41(6):522-32, 2021
                                                                  4. Zou Y et al: Assessment of complications and short-term outcomes of percutaneous peritoneal dialysis catheter insertion by conventional or modified Seldinger technique. Ren Fail. 43(1):919-25, 2021
                                                                  5. Morris CS: Interventional radiology placement and management of tunneled peritoneal dialysis catheters: a pictorial review. Radiographics. 40(6):1789-806, 2020
                                                                  6. Crabtree JH et al: Creating and maintaining optimal peritoneal dialysis access in the adult patient: 2019 update. Perit Dial Int. 39(5):414-36, 2019
                                                                  7. Tanasiychuk T et al: The ideal position of the peritoneal dialysis catheter is not always ideal. Int Urol Nephrol. 51(10):1867-72, 2019
                                                                  8. Lee J et al: Radiological Tenckhoff catheter insertion for peritoneal dialysis: a cost-effective approach. J Med Imaging Radiat Oncol. 62(2):174-8, 2018
                                                                  9. Crabtree JH et al: Peritoneal dialysis catheter insertion. Semin Nephrol. 37(1):17-29, 2017
                                                                  10. Crabtree JH: Peritoneal dialysis catheter implantation: avoiding problems and optimizing outcomes. Semin Dial. 28(1):12-5, 2015
                                                                  11. Gallieni M et al: Type of peritoneal dialysis catheter and outcomes. J Vasc Access. 16 Suppl 9:S68-72, 2015
                                                                  12. Abdel-Aal AK et al: Best practices consensus protocol for peritoneal dialysis catheter placement by interventional radiologists. Perit Dial Int. 34(5):481-93, 2014
                                                                  13. Bagul A et al: Laparoscopic peritoneal dialysis catheter (PDC) insertion: does it really make a difference? J Nephrol. 27(2):127-34, 2014
                                                                  14. Kuru S et al: Sclerosing encapsulating peritonitis with perforation of the gastrointestinal tract: a serious complication of continuous peritoneal dialysis. Ann Saudi Med. 32(6):660-1, 2012
                                                                  15. Singh SK et al: Peritoneal dialysis catheter malfunction because of encasement by an extraluminal fibrin sheath. Perit Dial Int. 32(2):218-20, 2012
                                                                  16. Dell'Aquila R et al: Rational choice of peritoneal dialysis catheter. Perit Dial Int. 27 Suppl 2:S119-25, 2007
                                                                  17. Rabindranath KS et al: Automated vs continuous ambulatory peritoneal dialysis: a systematic review of randomized controlled trials. Nephrol Dial Transplant. 22(10):2991-8, 2007