Peritoneal Dialysis Catheter Placement: Percutaneous and Peritoneoscopic Techniques

Abstract

Chronic peritoneal dialysis (PD) is an underutilized renal replacement therapy in treating end-stage renal disease that has several advantages over hemodialysis. The success of continuous ambulatory PD is largely dependent on a functional long-term access to the peritoneal cavity. Several methods have been developed to place the PD catheter using both surgical and percutaneous techniques. The purpose of this article is to describe the percutaneous techniques using fluoroscopy guidance and peritoneoscope method. While fluoroscopic method uses fluoroscopy guidance and a guidewire to place the PD catheter, the peritoneoscopic technique utilizes a needlescope to directly visualize the peritoneal space to avoid adhesions and omentum during catheter placement. These percutaneous approaches are minimally invasive procedures that can be performed on an outpatient basis without the need for general anesthesia.

Keywords: dialysis; image-guided; interventional; interventional radiology; percutaneous; peritoneal; peritoneoscopic; renal failure.

Fig. 1

Peritoneal dialysis catheter exit sites: ( a ) below the belt; ( b ) above the belt; ( c ) presternal.

Fig. 2

The location of both deep and superficial cuffs of the peritoneal dialysis catheter.

Fig. 3

( a ) Screening ultrasound to determine the point of entry; ( b ) contrast injection to confirm peritoneal cavity entry; ( c ) guidewire (arrow) is negotiated toward the pelvis; ( d ) change to 5-Fr sheath (arrow).

Fig. 4

Serial dilatation of the tract ( a–c ) and inserting the peritoneal dialysis catheter using the pull-apart sheath ( d – h ).

Fig. 5

Catheter in the peritoneal space ( a ). Creating the exit site ( b – c ), connecting the connector and extending tube and dressing of the catheter ( d – f ).

Fig. 6

Peritoneoscope and Y-TEC kit.

Fig. 7

( a ) Skin incision; ( b ) dissection until reaching the surface of the rectus muscle; ( c and d ) intraoperative ultrasound. ( e ) Small incision within rectus muscle; ( f ) entering the peritoneal space using the Quill assembly; ( g ) air insufflation; ( h ) inspecting the peritoneal space using peritoneoscope.

Fig. 8

(a) serial dilation of entry site; (b, c) mounting the PD catheter over the Stylette; (d, e) inserting the PD catheter within peritoneal cavity; (f) Stylette is removed and the deep cuff is buried.

Fig. 9

( a – c ) Tunneling the catheter; ( d ) closing the incision; ( e ) confirmation image of proper position of the peritoneal dialysis catheter; ( f ) final dressing.