Peritoneal dialysis catheter insertion

For Peritoneal Dialysis the fluid is left in your abdomen to do the dialysis for several hours, then drained out. This fluid takes away some of the waste products and excess water that are normally removed by the kidneys. Fresh fluid is then put into the abdomen.

This exchange of fluid takes about 30 minutes and you will do it 2 - 4 times a day. The fluid comes in a range of volumes and “strengths”. The type of fluid you use depends on your needs.

The catheter is inserted by a surgeon at Southmead Hospital. The operation will usually be a day case (you will not stay overnight) using general or local anaesthetic.

There are a few things to think about when choosing the position of your catheter. You will discuss this with your surgeon before the operation and the community dialysis nurse will mark the place you agree on your skin.

Things to think about:

• Where do the waistbands on your clothes and underwear sit? You may not want these to be on top of your tube or exit site as this could interfere with healing.
• Do you prefer to sleep on one side? You do not want the tube to come out of the side you sleep most on as it can be uncomfortable and may interfere with healing.
• Where are your natural skin folds when you are sitting? The exit site should not be in a fold.

Infection screening

Before the procedure we will take swabs of your nose and groin. This is to check if you are carrying any bacteria on your skin that could cause infection of the catheter.

If the swabs are positive you may need treatment to clear the bacteria before the procedure.

The usual treatment is:

• Cleaning your skin with antibacterial wash (Hibiscrub or Octenisan) for 5 days before the procedure.
• Applying antibacterial ointment (Mupirocin or Naseptin) to both nostrils 3 times a day, for 5 days before the procedure.

If for any reason you haven’t had the swab tests done before the procedure, they will be done when you are admitted. If treatment is required it will be started then for at least 5 days.

Medications

If you take warfarin, clopidogrel or any other blood-thinning tablets, you will need to stop taking these before the procedure. Your doctor or pre-operative assessment clinic (POAC) nurse will tell you when to stop taking them.

If you are having general anaesthetic

You will be given a date to attend the pre-operative assessment clinic (POAC). Some blood samples and swabs will be taken, and measurements of your blood pressure, pulse, temperature, and oxygen level.

If you are having local anaesthetic

Blood samples and swabs will be taken at the initial visit to your home. Before your surgery a member of the Renal Community Team will come to your house to go through the details of peritoneal dialysis (PD) including:

• Storage of dialysis fluids.
• Ordering stores and delivery.
• The area where you will do peritoneal dialysis.
• Handwashing technique and cleanliness.
• Instructions for how to keep the tube safe when you get home after the operation.

You will be given a date for your surgery. It is important your bowels are empty so you will be asked to take laxatives called sodium docusate and senna 3 days before the operation.

You will continue to take laxatives after the operation to make sure the PD tube won’t move because of constipation.

If you are having general anaesthetic

You will go to the medirooms.

If you are having a local anaesthetic

You will go to the renal ward 8b.

• If your operation is planned for the morning don’t have anything to eat or drink after 00:00 (midnight). If your operation is in the afternoon you will be given an early breakfast at around 06:00 - you won’t have anything to eat or drink after that.
• If you have diabetes that is treated with medication is it essential that you tell the nurses.
• You will be given antiseptic solution to shower with and then put on a clean theatre gown and anti-embolism compression socks.
• We cannot give you an exact time for your operation. Theatre lists need to be flexible in case of any emergencies. Everything possible will be done to make sure you don’t have to stop eating/drinking for any longer than necessary.
• Please don’t bring any valuables or large amounts of cash as we cannot be responsible for them.
• A member of the Renal Community Team will see you before the procedure to mark the position of the PD tube exit site.
• You will be asked to sign a consent form. The surgeon will explain what you should expect, including the reason for inserting the catheter and any possible complications to make sure you are aware of them.

What happens after the operation? 

• When you have recovered from the anaesthetic you will be given painkillers if you need them. You will be encouraged to eat and drink as soon as you feel like it.
• If you had general anaesthetic you will have blood tests to check kidney function and haemoglobin level.
• You will have dressings on your abdomen and a stitch (suture) closing the tube exit site. The stitch is usually dissolvable but if not you will have it removed 10 days later.
• You are likely to have some bruising on your abdomen.
• You will be able to go home the same day in most cases.
• You will have a phone number to ring if you have any problems.

What immediate follow-up care will I have? 

• The day after your operation a member of the Renal Community Team will phone you to check your recovery. They will give you a date to come for check-up usually 7 days later.
• We will check your wound and flush the PD tube to check it’s working.
• 2 - 3 weeks after your operation, you will have PD training which usually takes 3 days.
• 2 - 3 weeks after training you will come to the PD clinic to check your progress.

Most patients are advised to take 7 days of work to recover.

Some people need more than this, particularly if you have a manual job.

There are 4 main possible complications that may happen. 

Functional problems

Occasionally the catheter might not work. This might be because the tip of the catheter is in the wrong place or is covered by internal tissue which stops it working. At Southmead this happens in less than 7 in 100. 

Bleeding 

Bleeding can happen, mostly because of bruising around the wound. It usually stops on its own. In rare cases (less than 1 in 100) you may need surgery to stop the bleeding. 

Infection

You will have intravenous (IV) antibiotics when the catheter is inserted to prevent infection. Despite this, some patients develop infection at the catheter exit site which needs further antibiotics. This happens in less than 1 in 100 cases, and very occasionally the catheter may need to be removed.

There is also a risk of infection deeper in the abdomen, causing peritonitis in the first 2 weeks after insertion. This happens in about 3 in 100 cases, and will be treated with different antibiotics.

Bowel perforation

Very rarely during the procedure the bowel is cut by mistake. This happens in less that 1 in 100 cases. It is a serious complication that may need another operation and a stay in hospital.

A community nurse will look after your ongoing care, and they will keep in contact with you. This will involve some visits to your home. A follow-up clinic appointment will be arranged with one of the renal doctors after your training.

Hospital transport can be arranged for appointments and training, but this is only for patients who meet certain criteria. We encourage you to make your own arrangements if possible.