Peritoneal dialysis catheter placement

Published on 09/04/2015 by admin

Filed under Surgery

Last modified 09/04/2015

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CHAPTER 18 Peritoneal dialysis catheter placement

Step 2. Preoperative considerations

The indications for laparoscopic PD catheter placement are identical to those of PD catheter placement via conventional minilaparotomy, blind percutaneous Seldinger, or peritoneoscopic technique. Indications include an inability to tolerate hemodialysis (e.g., heart disease or extensive vascular disease) or a stated preference for peritoneal dialysis. The benefit of peritoneal dialysis is the ability to perform dialysis at home as long as the patient or an assistant has the capacity to perform exchanges properly.

Laparoscopic PD catheter placement allows complete visualization of precise intra-abdominal implantation, the ability to perform adhesiolysis if required, and the ability to secure the catheter in the pelvis if desired. For these reasons, both surgeons and nephrologists increasingly prefer laparoscopic PD catheter placement in comparison to the older methods of percutaneous Seldinger technique, peritoneoscopic approach, and open placement via minilaparotomy.

Contraindications to PD include the extensive adhesions that would prohibit adequate dialysate flow, an irreparable abdominal wall hernia, diaphragmatic defects predisposing to hydrothorax, and severe lung disease to a degree that increased intra-abdominal volume would compromise respiratory function. Morbid obesity is a relative contraindication.

Most experts feel that the initial higher cost of laparoscopic PD catheter placement is more than offset by the lower incidence of costly later complications in comparison with open surgical placement or blind percutaneous placement.

Appropriate preoperative teaching and arrangements for initial supervised sterile dressing changes should be made before operation.

Step 3: Operative steps