Department of Nephrology
It
Patient information sheet
Peritoneal dialysis catheter
insertion
Fasting required - no food or drink before the
procedure
This information is provided to you as you are to
have a peritoneal dialysis catheter inserted. It will
tell you why you are having this procedure, what is
involved, the risks involved, how to prepare for the
procedure, and what to expect after the procedure.
Why you are having the procedure
When your kidneys fail, you may need treatment
by peritoneal dialysis. This is one of the treatments
available for permanent (or chronic), kidney failure.
This treatment will remove excess fluid and waste
products from your blood stream as you have kidney
failure and your own kidneys are not working.
During peritoneal dialysis, you will run sterile (germ
free), fluid into the abdomen, which is also referred
to as the peritoneal cavity. The fluid will stay inside
your abdomen (tummy) for four to eight hours.
During this time, excess fluid and waste products
will be removed from your blood. When you drain
the fluid out of your peritoneal cavity, some excess
water and wastes will be removed. Many people
drain four bags of fluid in and out, every day. Each
bag change takes about 30 minutes. The fluid
also stays inside you while you sleep. This form of
dialysis is called continuous ambulatory peritoneal
dialysis (CAPD).
Some people use a different form of peritoneal
dialysis known as automated peritoneal dialysis
(APD), using a machine called a cycler. The
machine runs the fluid in and out of your body at
night while you sleep. The machine is used every
night.
The procedure
Before you can start peritoneal dialysis, an operation
is required to insert a catheter (or tube), into your
abdomen. The tube is sometimes referred to as a
tenckhoff catheter and allows fluid to flow in and
out of the abdomen so that you can have dialysis.
It has many small drain holes to let the fluid run in
and out quickly.
It is a soft, thin tube about 47 centimetres long.
will be inserted during a small surgical operation
which requires a general anaesthetic. Most of the
tube will be inside your abdomen, however around
29 centimetres will be outside your body. You will
connect your fluid bags to this tube, to run the fluid
in and drain the waste out. Inside your body the
tube will sit in front of your rectum and behind your
bladder. You will not feel it inside you.
Your operation will be done in an operating theatre
at Monash Medical Centre, Clayton. Most patients
have a general anaesthetic. The surgeon will
make a small cut in the lower abdomen to insert
the catheter. This will then be placed in the pelvic
area and will be stitched in place. The end of the
catheter will then be tunnelled under the skin to
protect it from infection. It will exit from the skin
about 15 centimetres from the operation site. The
point where the catheter leaves the skin is called
the exit site. Please refer to the diagram on the
final page.
Risks of the procedure
General risks
Potential complications include:
Having an anaesthetic may create heart problems
during or after an operation.
A sore throat may develop after a general
anaesthetic.
Infection in the wound area may need treatment
with antibiotics and may also delay healing of
the wound. This may occur inside the abdomen.
This is called peritonitis and will require antibiotic
treatment.
A chest infection may occur after any operation.
This usually requires antibiotics.
Bleeding may occur and a blood transfusion may
be required.
Blood clots can develop in the deep veins of the
lower body (deep vein thrombosis), which can be
life-threatening.
Risks specific to peritoneal catheter surgery
Rare complications include:
Perforation of an organ within the abdomen (such
as bowel or bladder).
The formation of scar tissue (called adhesions)
within the peritoneum. This occurs over time
as a consequence of infection, rather than being
associated with the operation itself.
Haematoma (blood clot) along the track of the
catheter as it runs beneath the skin.
 Blockage of the catheter causing inflow or You will have gauze, or clear dressing, over the
outflow problems may require a new catheter to operation site. Do not remove this dressing. It will
be inserted. be changed by the peritoneal dialysis nurses if
required, usually twice weekly. You will be able to
The major risk associated with the insertion of return to your normal activities gradually over the
a Tenckhoff catheter actually does not develop next week.
at the time of the operation, but rather when the
dialysis actually commences. If you have a hernia
in the abdominal wall or groin, this may trap some Special note
peritoneal fluid leading to enlargement of the hernia. Call the renal doctor, the renal registrar, or
Peritoneal fluid can sometimes track to the scrotum the peritoneal dialysis nurses (telephone
causing scrotal enlargement. Fluid can also leak 9594 3549), immediately if you experience:
into the abdominal wall itself. Fluid can also move
to the chest and surround the lungs. Such leakage A fever
of fluid may only become apparent after the dialysis A body temperature above 38 degrees celcius
begins. This is rare and not able to be predicted Abdominal pain that is not settling
before the operation. However, if this does occur Redness or discharge from the exit site
and cannot be repaired, it may make peritoneal
dialysis an unsuitable method of dialysis for you.
Post-operative care of your peritoneal
Preparing for the procedure dialysis catheter
The peritoneal dialysis nurses will choose the You will probably start peritoneal dialysis training
site for your peritoneal dialysis catheter. This will at least two weeks after the operation. Before
be below your waist, or the belt line of your discharge from the hospital you will need to make
clothes. It will usually be on the side of your a time to see the peritoneal dialysis nursing staff to
abdomen. have your dressing changed.
Medications that thin the blood such as aspirin
or warfarin and some arthritis drugs may need to You should not shower at home during this time, as
be stopped one week before the operation. the dressing must remain dry. You can have a wash
Please discuss this with your surgeon or renal instead. You may be able to shower at the hospital
physician. prior to having your dressing changed.
You should not be constipated before the
operation. You will be given some medication to
move your bowels before the operation.
Do not drink or eat anything before the
procedure.
If you have not yet started on dialysis, you may
need to have fluid through a drip while you are
fasting.
If you have a hernia in the abdominal wall or
a hernia in the groin, this will need to be repaired
by the surgeon at the time of the insertion of
your dialysis catheter. If the hernia is not repaired,
fluid may become trapped in the hernia causing
it to enlarge.

After the procedure

After the operation, the nurses will take your
blood pressure and pulse frequently and check for
bleeding. Your peritoneal dialysis catheter will have
a cap on the end and this should not be removed.
After the operation, wait until your surgeon says that
you can eat and drink before doing so. You will be
given some pain medication if you have discomfort
after the operation.