Peritoneal dialysis (PD) is a home-based treatment that helps filter waste products from the blood when kidneys can no longer perform this function. This process uses the lining of the abdomen, called the peritoneum, as a natural filter. A key component of this therapy is the peritoneal dialysis catheter, a soft, flexible tube surgically placed to allow fluids to be exchanged.
The Peritoneal Cavity: The Placement Site
The peritoneal dialysis catheter is placed into the peritoneal cavity, the space within the abdomen that houses organs like the stomach, intestines, and liver. This cavity is lined by the peritoneum, a thin membrane with two layers: the parietal peritoneum, which lines the abdominal wall, and the visceral peritoneum, which covers the organs. The large surface area of the peritoneum, typically 1 to 2 square meters, provides ample space for the exchange of waste products and excess fluid from the blood. Its extensive network of capillaries allows for efficient diffusion and osmosis, the fundamental principles behind peritoneal dialysis.
The Catheter Placement Procedure
Placing a peritoneal dialysis catheter is a minor surgical procedure, typically performed by a surgeon. It usually takes 60 to 90 minutes and can be done under local anesthesia with sedation or general anesthesia. A small incision, usually 2 to 5 centimeters long, is made in the lower abdomen, often below the navel. The catheter is then guided through this incision into the peritoneal cavity.
A common technique involves tunneling a portion of the catheter under the skin for several inches before it exits the body. This creates a barrier against infection. The catheter has one or two Dacron cuffs positioned under the skin to promote tissue growth. These cuffs anchor the catheter in place and further reduce infection risk.
Life with a Newly Placed Catheter
Immediately following catheter placement, patients enter a healing period where exit site care is important. The surgical wound needs time to heal, typically two to four weeks, and patients receive instructions on how to keep the site clean and dry. Pain around the incision site is common in the first few days and can be managed with prescribed pain relievers.
During this initial phase, avoiding strenuous activities, heavy lifting, and swimming is advised to prevent strain and allow proper healing. The catheter exit site must be protected from trauma and kept free from contamination. Most patients undergo a “break-in” period, lasting one to two weeks, during which small volumes of dialysis solution may be infused to allow the body to adjust before regular treatments begin.
Common Concerns After Placement
After a peritoneal dialysis catheter is placed, some concerns can arise. One common issue is an exit site infection, which can manifest as redness, swelling, pain, or pus around where the catheter leaves the skin. Recognizing these signs early and contacting a healthcare provider for prompt treatment is important to prevent more serious complications.
Another concern is catheter migration, where the tip of the catheter moves from its optimal position within the peritoneal cavity. This can lead to issues with fluid drainage or infusion during dialysis treatments. Leakage of dialysis solution around the exit site is also possible, particularly in the days immediately following placement. This can indicate the wound needs more time to seal or that the catheter is not properly seated. Any of these observations warrant immediate communication with the healthcare team.