Peritoneal Dialysis Catheter Insertion: Placement of a Tenckhoff catheter in the abdomen
Your doctor has recommended, on the basis of your blood results and how you are feeling, that you need to start dialysis treatment for kidney failure. You have opted for peritoneal dialysis.
The peritoneum is a natural membrane that lines the organs in the abdomen (tummy area). In Peritoneal Dialysis (PD) it is used as a filter, to clean the blood, when your kidneys are no longer performing well enough to keep you healthy. In order to do this, a permanent tube known as a Tenckhoff Catheter needs to be placed in the lower part of your belly. This is used to run in and drain out dialysis fluid. This soft, flexible tube lies flat against your body. There is no opening and no odour.
In the ‘manual’ system, known as CAPD (Continuous Ambulatory Peritoneal Dialysis), the fluid is left in your abdomen to do the dialysis for several hours and then drained out, taking with it some of the waste products and excess water normally removed by the kidneys. Fresh fluid is then run into the abdomen. This exchange of fluid is repeated 3 or 4 times during the day and takes about 30 minutes each time. The fluid comes in a range of volumes and ‘strengths’; these remove different amounts of excess water, depending on your individual and changing needs.
At Southmead Hospital, the catheter is inserted by a surgeon in an operation that is usually carried out under general or local anaesthetic. Both are day case procedures.
You will have the opportunity to discuss these issues with your surgeon before the operation, and the agreed site will be marked on your skin.
Before the procedure is carried out, you will have swabs taken of your nose and groin, to check whether you are carrying any bacteria on your skin surface that could cause infection of the catheter. If the swabs are positive, you may need to have some treatment to clear the bacteria before the procedure can be carried out.
The usual treatment is:
You will get a leaflet with full instructions when you are given the medications to take home.
If for any reason you have not had these tests done in advance of the procedure, they will be done when you are admitted and if treatment is required it will be started then (the treatment still needs to last for 5 days).
If you take warfarin, clopidogrel or other blood-thinning tablets, you will need to stop taking these before the procedure is carried out. Your doctor or pre-operative assessment clinic (POAC) nurse will advise exactly when to stop taking these tablets.
You will be given a date to attend the pre-operative assessment clinic (POAC) in preparation for your surgery. Some blood samples will be taken and swabs along with measurements of your blood pressure, pulse, temperature and oxygen level.
Bloods and swabs will be taken at the initial visit to your home.
A member of the renal community team will come to your house and visit you to go through the practicalities of peritoneal dialysis, including:
You will be given a date for your surgery. It is important that your bowels are empty before the operation. 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 which will ensure that the PD tube inside you will not move because of constipation. Constipation can push the PD tube into the wrong place, which can cause a PD fluid drainage problem.
You will attend the medirooms.
You will attend renal ward 8B.
Most patients are advised to take 7 days off work to recover from the procedure.
Some people need more than this and some people need less. If you have a manual job, you are more likely to need more time off.
There are four main possible complications that could occur with this procedure.
Occasionally, the catheter may not work despite apparently successful insertion. This may be due to the tip of the catheter sitting in the wrong place, or getting covered by internal tissue, which stops it working. At this unit, this occurs in less than 7 per cent of insertions (fewer than 7 in every 100 insertions).
Bleeding may occur, mostly as a result of bruising around the wound, and it usually stops of its own accord. In fewer than 1 in 100 insertions (less than 1 per cent), you may need to have more surgery to stop the bleeding.
You will be given intravenous antibiotics at the time of the catheter insertion to prevent infection. Despite this, some patients develop infection at the catheter exit site, which requires treatment with a further course of antibiotics. This occurs in less than 1 per cent of insertions (less than 1 in every 100 done).Very occasionally this may require the catheter to be removed.
There is also a risk of infection developing deeper in the abdomen, causing peritonitis in the immediate post-op period (the first two weeks after insertion). At our unit, this occurs in around 3 per cent of insertions, and will be treated with different antibiotics.
Very occasionally during the course of the procedure, the bowel is cut by mistake. This occurs in fewer than 1 in 100 insertions (i.e less than 1 per cent). This is a serious complication that may require a surgical operation and an inpatient stay in hospital.
A community team nurse will be allocated to look after your ongoing care and he or she 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 training.
Hospital transport can be provided for all your hospital appointments and training, if necessary, but we do encourage you to make your own arrangements if possible.
Renal Community Team
Level 1, Gate 5
Brunel building
Southmead Hospital
BS10 5NB
If you or the individual you are caring for need support reading this please ask a member of staff for advice.
If you’re an overseas visitor, you may need to pay for your treatment or you could face fraud or bribery
charges, so please contact the overseas office: Tel: 0117 414 3764 Email: overseas.patients@nbt.nhs.uk