Peritoneal Dialysis - PD Catheter
In order to carry out PD it is necessary to have a plastic tube known as a PD catheter inserted into the abdomen (tummy). The PD tube or catheter is about 30cm (12in) long and as wide as a pencil. The most commonly used type of PD catheter is called a “Tenchkoff” (pronounced Ten coff). Around half of the catheter lies inside the abdomen, and half lies outside the body. The site where the catheter enters and leaves the skin is called the ‘exit site’, and this is kept covered with a small dressing. An operation is needed to insert the catheter.
The length of time that people spend in hospital will vary depending on whether the PD catheter insertion is under a local or a general anaesthetic. For a local anaesthetic (the person remains awake for the operation) the person comes into hospital and goes home on the same day. For a general anaesthetic (the person is asleep during the operation) usually the person comes into hospital on the day before, or the day of the PD insertion, and goes home 1-2 days after the insertion. Some people stay in, and start their PD training a few days after their insertion, if their blood results show that they need to have dialysis straight away. People are generally given a date to return for PD training, often 2-6 weeks after the insertion.
The preparation that is needed before the PD insertion will vary somewhat depending on whether the insertion is under general or local anaesthetic, and the Unit where you are treated. For all types of insertion the person will need to have a physical examination by a doctor, and notes made on their medical history. The physical examination is to ensure the person is fit enough to have the insertion, and check for a hernia (muscle weakness of the wall of the tummy), or any other tummy problems. The person will also need to have blood tests, antibiotics (Renal Unit policies vary) and empty their bowel and bladder before the operation. Once the procedure, and potential risks, have both been explained, a doctor will ask the person to sign a form giving their consent to the operation.
The insertion procedure will vary somewhat depending on whether the insertion is under local or general anaesthetic. For all insertions the person will have a cut or incision made just below their belly button, and one end of the catheter will be placed in the peritoneal cavity. The other end will be tunnelled through the abdomen and comes out of a small hole known as the Exit Site.
After the operation is finished the surgeon often puts some local anaesthetic into the wound, and this should stop the person from feeling sore for several hours. As with many operations some people are more troubled than others by pain. People should expect some pain, and know that they will be given painkillers if needed, for as long as they need them.
The cut or incision for a PD insertion is usually about 8-10cms (4inches) or smaller if it is an insertion under local anaesthetic. A downward cut is usually made below the belly button, but it can be across the tummy. The wound is stitched or stapled. The stitches (sometimes dissolvable ones are used) or staples are usually taken out after 10 days. If the person’s skin normally heals quite well, they will only have a faint line where the incision took place when the skin heals. The site where the catheter leaves the body is a small hole and this should heal fully after a couple of months.
After the operation the person’s blood pressure and pulse will be checked, and the wound site examined at regular intervals to ensure that there is no undue bleeding from the operation site. The PD nurse will flush small volumes of fluid through the catheter until the fluid that comes out is clear (Some Units do this, others do not flush the catheter). The fluid is a reddish pink colour to begin with because some blood is mixed with the fluid. On the day after the operation the person or their carer will be shown how to care for the exit site.
Most people will go home one or two days after the operation. Before going home, arrangements will be made to have the stitches to the operation site removed after tens days (by a district nurse, a nurse at the GP’s, or by a PD or ward nurses). Most people will be given laxatives to take to keep their bowels regular. If a person is constipated when they return for their training the catheter will not work.
Between 1 and 2 people in 20 experience complications after catheter insertion. The most common complication of a PD insertion is an infection of the tummy called peritonitis.
As with any operation to the tummy there is a risk that the bowel, the bladder, or a large blood vessel is damaged. In some cases the catheter does not work, because the part of the catheter that stays in the body moves after the operation, and a second operation is needed to reposition it. Fluid can also leak out of the exit site, or leak downwards into the scrotum (in males) or vagina (in females).
Following a PD insertion people are advised not to lift anything heavy for around 6 weeks. This is to prevent the catheter from moving, or damage to the wound or tummy. It takes around 6 weeks to heal. Therefore people who work, generally get signed off work for this period and often do their PD training before returning to work.
Gentle exercise or sexual activity can usually be resumed after 2 weeks. It is sensible for people to ask their doctor for individual advice. People should check with their doctor, or with their car insurance company regarding how soon before they can resume driving.
The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.