Peritoneal Dialysis Catheter Placement Techniques

The success of catheter placement is critically important for the ability to stay on peritoneal dialysis over the long-term. Nephrologists have used percutaneous placement with or without fluoroscopic guidance and placement using peritoneoscopic guidance to place these catheters. Complications can be divided into early, within 14 days, and late complications, those arising more that 14 days after the procedure. The main post-procedure complications are infection, leakage, and obstruction. Results of non-invasive placement have been comparable to surgical placements. The noninvasive technique is simple with minimal intra-operative morbidity, and a post-placement complication rate better than surgical placements. Comparing percutaneously placed catheters to laparoscopically and peritoneoscopically placed catheters shows that the laparoscopic technique has a better one year survival rate. In deciding which technique is best for the patient, it is important to identify advantages of percutaneous placement, such as use of local anesthesia, lower rates of complications, the fact that it is a bedside or office procedure, versus the limitations in that the percutaneous method is not suited for obese patients or those patients likely to have peritoneal adhesions. Peritoneal catheters can be placed in a timely manner without delays associated with surgical scheduling. This offers an added option, both to the neprhologist and the patient and may avoid starting dialysis using a central venous catheter. The placement of peritoneal dialysis catheters by nephrologists has been shown to increase utilization of peritoneal dialysis as a dialysis modality, and this is an important advantage of the procedure.