Peritoneal Catheter Placement: A Guide to Procedure, Uses, and Recovery

Andrew Kowalski, MD, FASN

Introduction

Peritoneal catheter placement is a surgical procedure used to insert a catheter into the peritoneal cavity, primarily for peritoneal dialysis, ascitic fluid drainage, or chemotherapy administration. This minimally invasive procedure is vital for patients with kidney failure, chronic ascites, or certain cancers requiring intraperitoneal chemotherapy. Understanding the procedure, indications, and recovery process can help patients and caregivers prepare for what to expect.

What Is a Peritoneal Catheter?

A peritoneal catheter is a soft, flexible tube placed in the abdomen to allow the exchange of fluids within the peritoneal cavity. The most common type is the Tenckhoff catheter, used for peritoneal dialysis in patients with end-stage renal disease (ESRD). Other catheters may be used for draining excess fluid in conditions like malignant ascites or delivering chemotherapy.

Indications for Peritoneal Catheter Placement

A peritoneal catheter is placed for various medical reasons, including:

1. Peritoneal Dialysis (PD):

• Used in patients with kidney failure to remove waste products and excess fluids.

• Offers an alternative to hemodialysis, allowing at-home treatment.

2. Management of Ascites:

• Helps drain excess abdominal fluid caused by conditions like liver cirrhosis or cancer.

• Provides symptomatic relief and improves comfort.

3. Intraperitoneal Chemotherapy:

• Used for direct chemotherapy administration in abdominal cancers like ovarian cancer.

The Peritoneal Catheter Placement Procedure

Before catheter placement, patients typically undergo:

• A physical examination and medical history review.

• Imaging studies (ultrasound or CT scan) to assess the abdominal cavity.

• Blood tests to ensure proper clotting function.

• Fasting for a few hours before the procedure.

Surgical Procedure

The procedure can be performed under local, regional, or general anesthesia, depending on the patient’s condition. The two common techniques include:

1. Open Surgical Technique: (These are the type of catheters I place at our surgical center)

• A small incision is made in the abdomen.

• The catheter is inserted into the peritoneal cavity and tunneled under the skin.

• The exit site is secured with sutures to prevent infection.

Picture of me (Andrew Kowalski, MD) placing a peritoneal dialysis catheter in a patient

2. Laparoscopic Placement:

• A minimally invasive approach using small incisions and a camera-guided insertion.

• Preferred for better catheter positioning and lower complication rates.

Postoperative Care

After the procedure:

• The catheter is secured with dressings to prevent movement and infection.

• Patients are monitored for complications such as bleeding, infection, or leakage.

• Training on catheter care and fluid exchange is provided before discharge.

A fluoroscopic picture of a properly placed peritoneal dialysis catheter

Recovery and Aftercare

Initial Recovery

• Most patients recover within 1 to 2 weeks after catheter placement.

• Mild pain and swelling are common but improve with proper care.

• Patients should avoid heavy lifting and strenuous activities during the healing period.

Long-Term Catheter Care

Proper catheter care is crucial for preventing infections like peritonitis. Key aspects include:

• Daily Cleaning: The exit site should be cleaned with antiseptic and covered with a sterile dressing.

• Hygiene Practices: Avoid soaking the catheter in water (e.g., bathtubs) and opt for showers instead.

• Monitoring for Infection Signs: Watch for redness, swelling, pus discharge, or fever.

Potential Complications

Although the procedure is generally safe, some complications may arise, including:

1. Infections: Peritonitis or exit-site infections require prompt antibiotic treatment.

2. Catheter Malfunction: Blockage or displacement may need repositioning.

3. Fluid Leaks: Can occur at the exit site and require careful management.

4. Pain or Discomfort: Often temporary but should be reported if persistent.

Conclusion

Peritoneal catheter placement is a life-changing procedure for patients requiring long-term dialysis, fluid drainage, or chemotherapy. With proper technique, post-procedure care, and monitoring, patients can achieve better health outcomes and maintain a good quality of life. If you or a loved one is considering peritoneal catheter placement, consulting with a healthcare provider can help determine the best approach for your condition.

Would you like to learn more about catheter care tips or specific complications? Let me know!