Absolute and Relative Contraindications for Tunneled Peritoneal Drainage Catheter Placement
The only absolute contraindication for tunneled peritoneal drainage catheter placement is mechanical obstruction of the small bowel, unless the catheter is being placed specifically for decompression. 1
Absolute Contraindications
- Mechanical obstruction of the small bowel (except when catheter is for decompression) 1
- Documented loss of peritoneal function 1
- Uncorrectable mechanical defects that prevent effective peritoneal drainage or increase infection risk (e.g., surgically irreparable hernia, omphalocele, gastroschisis, diaphragmatic hernia) 1
- Patient who is physically or mentally incapable of managing the catheter without a suitable assistant 1
Relative Contraindications
Abdominal/Anatomical Factors
- Fresh intra-abdominal foreign bodies (e.g., recent abdominal vascular prostheses, ventricular-peritoneal shunt) 1
- Requires 4-month wait after placement of abdominal vascular prostheses
- Requires 6-16 weeks healing time for newly implanted prostheses
- Peritoneal leaks 1
- Active gastrointestinal bleeding due to peptic ulcer 1
- Inflammatory or ischemic bowel disease 1
- Abdominal wall or skin infection 1
- Frequent episodes of diverticulitis 1
- Large midline wounds, chest tubes, abdominal mesh, and ostomies (make finding safe window challenging) 1
- Morbid obesity, particularly in short individuals 1
- Large hiatal hernias 1
- Abdominal wall hernias 1
- Peritoneal carcinomatosis 1
Patient Factors
- Hemodynamic instability 1
- Respiratory instability 1
- Severe malnutrition (compromises wound healing) 1
- Body size limitations (either too small to tolerate prescribed dialysate volume or too large to achieve adequate dialysis) 1
- Intolerance to peritoneal volumes necessary to achieve adequate drainage 1
Special Considerations
Ascites 1
- Can impair wound healing and apposition of the gastric wall to the abdominal wall
- Recommendation: Drain ascitic fluid via paracentesis or intraperitoneal drain placement before catheter insertion
- Consider using T-tacks to improve tract formation
Ventriculoperitoneal (VP) shunts 1
- Increased risk of infectious complications
- Recommendation: Place gastrostomy concurrently with VP shunt or before VP shunt placement rather than within 15 days after VP shunt placement
- Consider longer courses of perioperative antibiotics when placed in individuals with existing VP shunts
Peritoneal dialysis 1
- Risk of peritonitis
- Recommendation: Convert to or maintain hemodialysis for 6 weeks to reduce (but not eliminate) risk of peritonitis
Severe dysmotility and esophageal varices 1
- Not absolute contraindications but can make site identification more difficult
- May place patient at higher risk of aspiration
- Recommendation: Adequate sedation with anesthesia support can aid in successful placement
Complication Risks to Consider
- Infection risk increases with longer catheter dwell time (median 96.5 vs. 20 days for those with vs. without infection) 2
- Catheter-related complications include:
Clinical Pearls
- For patients with ascites, draining ascitic fluid before catheter placement improves success rates 1
- Patients with malignant ascites have significantly shorter survival time after catheter placement compared to those with non-malignant ascites (median 18.5 vs. 85 days) 2
- Despite relative contraindications, tunneled peritoneal catheters have shown high technical success rates (100%) in appropriate patients 2
- Most complications are manageable and don't require catheter removal 4, 2
When considering placement of a tunneled peritoneal drainage catheter, carefully evaluate for absolute contraindications first, then weigh the relative contraindications against the potential benefits of the procedure based on the patient's clinical condition and goals of care.