From the Guidelines
Peritoneal dialysis does not use vascular access but instead utilizes a peritoneal catheter. This catheter is surgically implanted into the patient's abdomen, extending from the peritoneal cavity to outside the body. Unlike hemodialysis, which requires direct access to the bloodstream through arteriovenous fistulas, grafts, or central venous catheters, peritoneal dialysis works by using the patient's peritoneal membrane as a natural filter. The catheter allows dialysis fluid (dialysate) to flow into the peritoneal cavity, where waste products and excess fluid from the blood vessels surrounding the peritoneum diffuse into the dialysate. After a prescribed dwell time, the fluid containing these waste products is drained out through the same catheter. The peritoneal catheter is typically a soft, flexible tube made of silicone or polyurethane with multiple small holes at the intra-abdominal end to facilitate fluid flow. Proper catheter placement and exit site care are essential to prevent complications such as peritonitis, exit-site infections, or catheter malfunction.
Key points to consider:
- The peritoneal catheter is the primary access device for peritoneal dialysis, not vascular access 1.
- The catheter is designed to facilitate the exchange of dialysate and waste products, and its proper placement and care are crucial to preventing complications 1.
- Peritoneal dialysis is a distinct modality from hemodialysis, with its own set of advantages and considerations, including the use of a peritoneal catheter rather than vascular access 1.
In terms of morbidity, mortality, and quality of life, the use of a peritoneal catheter in peritoneal dialysis is generally considered to be a safe and effective approach, with benefits including reduced risk of infection and other complications compared to vascular access 1. However, it is essential to carefully evaluate each patient's individual needs and circumstances to determine the most suitable dialysis modality and access device.
From the Research
Vascular Access in Peritoneal Dialysis
- The type of vascular access used in peritoneal dialysis is a peritoneal catheter, which provides a permanent and safe access to the peritoneal cavity 2.
- The most commonly used peritoneal dialysis catheter is the Tenckhoff catheter, which has been the standard since its introduction in the mid-1960s 2, 3.
- The insertion of the peritoneal dialysis catheter can be accomplished by various techniques, including dissective or surgical, blind or modified Seldinger, and laparoscopic techniques 4.
- Laparoscopic techniques, such as the peritoneoscopic insertion, allow for direct visualization of the intraperitoneal structures and have been shown to have less incidence of complications and longer catheter survival rates 4.
- The management of peritoneal dialysis catheter insertion surgery is crucial to achieve successful peritoneal dialysis, and secure catheter insertion can lead to less infection and peritonitis 5.
Types of Peritoneal Dialysis Catheters
- The Tenckhoff catheter is a double-cuffed coiled catheter made of silicon tubing with attached Dacron cuffs 6.
- Other types of peritoneal dialysis catheters have been proposed, but none have significantly reduced the predominance of the Tenckhoff catheter 2.
Complications and Management
- Catheter-related problems, such as infection, exit site leak, and peritonitis, are common complications of peritoneal dialysis 2, 4.
- The 'pull' technique for removal of peritoneal dialysis catheters has been shown to be a safe method with low risk of infection 6.
- Proper peritoneal dialysis catheter insertion surgery and management can lead to less infection and peritonitis, and are crucial to achieve successful peritoneal dialysis 5.