Where is the peritoneal dialysis catheter (PD cath) placed?

Peritoneal Dialysis Catheter Placement

The peritoneal dialysis catheter tip should be placed in the deep pelvic area with the catheter tunneled through the abdominal wall, typically exiting in the lateral abdominal region.

Optimal Placement Location

The peritoneal dialysis (PD) catheter is optimally positioned with:

• Catheter tip location: Deep pelvic area (dependent position)
• Entry point: Through the abdominal wall, often near the umbilicus
• Exit site: Lateral abdominal wall, away from the belt line
• Tunnel: Subcutaneous pathway between entry and exit points

Placement Techniques

Several approaches can be used for PD catheter placement:

• Open surgical technique: Provides direct visualization and secure placement with lower risk of early mechanical complications (1.3% vs 7.9% with percutaneous) 1
• Laparoscopic technique: Allows visualization of the peritoneal cavity and precise catheter tip positioning
• Percutaneous technique: Less invasive but associated with higher risk of technical failures (5.6% vs 0% with open technique) 1

Catheter Configuration

The catheter configuration significantly impacts function and migration risk:

• Double-cuff, Swan-neck, curled-end catheters are superior in preventing catheter migration (less than 1% migration rate compared to 15% with straight catheters) 2
• The Swan-neck configuration (60-degree bend between cuffs) is an independent factor in preventing catheter migration 2

Right vs. Left Placement

Research suggests potential benefits to right-sided placement:

• Placement in the right lower quadrant is associated with significantly lower catheter tip migration rates (3.6%) compared to left-sided placement (19.3%) 3
• Right-sided catheters may require less surgical repositioning when migration occurs 3

Catheter Function Considerations

While optimal positioning is important, it's worth noting that:

• Some research suggests catheter function may not be strictly dependent on perfect positioning in the pelvis 4
• Drainage times may be slightly faster with correctly positioned catheters (14.7 vs 15.8 minutes) but the difference is not always statistically significant 4

Complications of Improper Placement

Poor catheter placement can lead to:

• Catheter migration
• Poor dialysate flow
• Abdominal pain during infusion or drainage
• Leakage around the catheter site
• Infection at the exit site or tunnel

Pain Management with PD Catheters

If patients experience pain with their PD catheter:

• Evaluate timing of pain (during infusion, full dwell, or drainage) to determine if it's related to catheter position 5
• Consider reducing dialysate fill volume by 25-50% to decrease intra-abdominal pressure 5
• More frequent exchanges with smaller volumes may help maintain clearance while reducing pressure 5

Best Practice Recommendations

For optimal PD catheter placement:

1. Use double-cuff, Swan-neck, curled-end catheters
2. Consider right-sided placement when possible
3. Position the catheter tip in the deep pelvic area
4. Create a subcutaneous tunnel with the exit site on the lateral abdominal wall
5. Consider open surgical or laparoscopic placement for direct visualization
6. Ensure proper catheter fixation to prevent displacement

Following these guidelines will help maximize catheter function and minimize complications, supporting optimal peritoneal dialysis outcomes and patient quality of life.