What is the proper size of a Tenckhoff (peritoneal dialysis) catheter for a patient weighing 48kg?

Tenckhoff Catheter Sizing for a 48kg Patient

For a patient weighing 48kg, use a standard adult Tenckhoff catheter with an instilled dialysate volume of 2.0-2.5 liters per exchange, based on the patient's body surface area (BSA) which will be approximately 1.4-1.5 m² for this weight range. 1

Catheter Selection

• Standard adult Tenckhoff catheters do not vary in diameter based on patient size—the catheter itself comes in a universal adult size, typically with a 6.5mm outer diameter 2
• The critical variable is not the catheter size, but rather the instilled dialysate volume, which must be adjusted based on BSA 1
• Double-cuff catheters with coiled intraperitoneal segments are generally preferred over single-cuff designs 2

Volume Prescription Based on Body Surface Area

For a 48kg patient (assuming average height, BSA approximately 1.4-1.5 m²):

• Initial instilled volume should be 2.0-2.5 liters per exchange 1
• For CAPD (continuous ambulatory peritoneal dialysis): Start with 2.5L exchanges if BSA is between 1.7 m² 1
• For patients with BSA <1.7 m² (which includes your 48kg patient): Start with 2.0-2.5L exchanges 1

Pediatric Considerations (If Patient is Adolescent)

If this 48kg patient is a pediatric/adolescent patient rather than a small adult:

• Target instilled volume of at least 1,100 mL/m² BSA is recommended, with individual tolerance considered 1
• For a BSA of 1.4-1.5 m², this translates to approximately 1,540-1,650 mL minimum per exchange 1
• The volume range should be 1,000-1,200 mL/m² BSA as the target, with a maximum of 1,400 mL/m² if tolerated 1

Important Clinical Considerations

• Body size can be a relative contraindication to PD when the patient is too small to tolerate the prescribed dialysate volume 1
• However, a 48kg patient is generally adequate size for standard adult PD 1
• Determine 4-hour drain volumes during training to assess if the patient tolerates the prescribed volume and to identify any mechanical problems 1
• Monitor for evidence of leakage in the vicinity of the catheter, as smaller patients may have increased intra-abdominal pressure with standard volumes 1

Volume Optimization Strategy

• First increase the instilled volume per exchange (as tolerated) before increasing the number of exchanges per day to optimize small-solute clearance 1
• Start with lower volumes (2.0L) and gradually increase to 2.5L based on patient tolerance 1
• Assess for symptoms of volume intolerance including abdominal pain, shortness of breath, or loss of appetite 1

Common Pitfalls to Avoid

• Do not assume pediatric sizing is needed simply because the patient weighs 48kg—if this is an adult, use standard adult volumes adjusted for BSA 1
• Avoid starting with maximum volumes immediately—begin conservatively and titrate up based on tolerance during the training period 1
• Do not delay baseline peritoneal equilibration testing (PET)—this should be performed approximately 1 month following initiation to rule out transport abnormalities 1