Perioperative management - Peritoneal dialysis: Open catheter insertion in CAPD

• End-stage renal disease with planned peritoneal dialysis
• Hemodialysis not possible because of technically insufficient vascular access

Patient not suited for peritoneal dialysis:

• Due to intra-abdominal adhesions or masses
• When proper handling of the catheter is not ensured

• Clinical examination: Ruling out any type of hernia
• History of abdominal surgery and inspection of all present scars
• Abdominal ultrasound study: Ruling out malignancies, assessing the size of polycystic kidneys and renal cysts

1 week before surgery

• No more heparin or insulin injections into the abdominal wall, thereby sparing the surgical site and reducing the risk of infection.

Day before surgery

• Standard preparation for surgery
• Enema the evening before the procedure
• Preoperative markup with the patient standing and sitting. Waistband (1), abdominal fold/pendulous abdomen (2), planned catheter exit site (3)

Since the CAPD is performed by the patient the catheter exit site must be easily visible for him/her. Thus, the exit site must not be located at the level of the waistband (outerwear/underwear), in skin folds or below a pendulous abdomen. Since most patients change the dialysate while sitting, the planned catheter exit site should also be checked before surgery with the patient sitting.

Day of surgery

• Single-shot antibiotic (e.g., cefazolin) before anesthesia is initiated
• Possibly Foley catheter for the duration of surgery.

General complications

• Injury to the small and large intestines
• Injury of parenchymal organs
• Wound infection, abscess, peritonitis, revision surgery
• Bleeding within the abdominal cavity and/or abdominal wall
• Positioning injuries
• Thromboembolism

Specific catheter complications

• Catheter kinking
• Catheter malposition, leakage, cuff dislocation.