Peritoneal Dialysis Catheter Insertion
Peritoneal Dialysis Catheter Insertion places a soft, flexible Tenckhoff catheter into the abdominal peritoneal cavity — creating reliable long-term access for peritoneal dialysis and allowing patients to perform their own dialysis at home, offering greater flexibility and independence compared to haemodialysis.
Overview
Peritoneal Dialysis Catheter Insertion places a double-cuff silicone Tenckhoff catheter through the abdominal wall into the peritoneal cavity, where the curled tip lies freely in the pelvis and the two subcutaneous cuffs anchor the catheter securely to prevent displacement and infection. Through this catheter, dialysis fluid is introduced into the peritoneal cavity, dwells for a prescribed period to allow toxin and fluid exchange across the peritoneal membrane, and is then drained — a cycle that can be performed at home either manually (CAPD) or automatically overnight (APD). PD catheter insertion is typically performed at least 2 to 4 weeks before dialysis is initiated to allow the exit site and tunnel to heal fully.
Types of Peritoneal Dialysis Catheters and Insertion Techniques
Several catheter designs and insertion approaches are available, with the choice determined by patient anatomy, surgical history, and the clinician's experience.
- Open Surgical PD Catheter Insertion (midline or paramedian approach — direct visualisation)
- Laparoscopic PD Catheter Insertion (minimally invasive — better catheter positioning and lower omental wrapping risk)
- Percutaneous Blind Insertion (bedside technique for urgent access)
- Swan-Neck Catheter (pre-bent catheter shape reducing exit site infection risk)
- Straight Tenckhoff Catheter (standard double-cuff silicone catheter)
Risk Factors for End-Stage Kidney Disease Requiring Peritoneal Dialysis
The conditions leading to end-stage renal disease requiring peritoneal dialysis are the same as those requiring any form of renal replacement therapy.
- Diabetic nephropathy with progressive loss of glomerular filtration rate
- Hypertensive nephrosclerosis causing chronic kidney disease progression
- IgA nephropathy and other chronic glomerulonephritis leading to ESRD
- Autosomal dominant polycystic kidney disease with bilateral kidney destruction
- Lupus nephritis causing irreversible renal damage despite treatment
- Congenital renal anomalies causing chronic renal failure in younger patients
Symptoms Requiring Renal Replacement Therapy
These symptoms indicate that the kidneys can no longer maintain life without external support, and renal replacement therapy — either haemodialysis or peritoneal dialysis — must be initiated promptly.
- Severe uraemic symptoms including intractable nausea, vomiting, and encephalopathy
- Refractory fluid overload causing pulmonary oedema unresponsive to diuretics
- Severe hyperkalaemia threatening cardiac arrhythmia
- Uncontrolled metabolic acidosis
- Uraemic pericarditis or pleuritis
- Bleeding tendency from uraemic platelet dysfunction
- eGFR below 10 mL/min/1.73m² with symptomatic uraemia
- Rapidly declining kidney function with expected imminent need for dialysis
Key Benefits
Discover the advantages of choosing our peritoneal dialysis catheter insertion services.
Provides reliable long-term peritoneal access enabling home-based dialysis immediately on healing
Laparoscopic approach reduces wound complications and allows earlier catheter use
Correct initial positioning dramatically reduces early catheter dysfunction
Patient independence through home dialysis significantly improves quality of life
Specialist PD nurses provide comprehensive training and 24-hour support after discharge
Clinical Features
The technology, techniques and clinical approach behind our peritoneal dialysis catheter insertion.
Laparoscopic insertion provides direct vision confirmation of correct catheter position in the pelvis
Double-cuff design — deep muscular and superficial subcutaneous — provides dual infection barrier
Deep cuff anchoring within rectus muscle prevents catheter dislodgement
Flow testing of inflow and drainage before closure confirms immediately functional placement
PD nursing team begins exit site care training before discharge from hospital
Preparation Instructions
After PD Catheter Insertion, protect the exit site from trauma and keep it clean and dry according to the PD nursing team's specific instructions — meticulous exit site care is the single most important factor in preventing catheter infection. Avoid baths, swimming, and submerging the exit site in water until the tunnel is fully healed at 2 to 4 weeks. Attend all PD nursing training sessions before initiating dialysis to ensure confident, safe home dialysis technique. Contact your PD team immediately for exit site redness, discharge, increasing tenderness, fever, or cloudy dialysis drainage fluid.
The Procedure
Step-by-step guide to what you can expect during your peritoneal dialysis catheter insertion procedure.
Pre-Operative Assessment and Planning
Your surgeon reviews your abdominal CT to assess for adhesions from previous surgery, plan the catheter insertion technique, choose the optimal exit site location, and confirm the laparoscopic or open approach most appropriate for your abdominal anatomy.
Anaesthesia and Sterile Preparation
General or spinal anaesthesia is administered and the abdomen and planned exit site are prepared in a sterile manner. The laparoscopic ports or surgical incision site are confirmed before the procedure begins.
Peritoneal Entry and Catheter Advancement
The peritoneal cavity is entered and the double-cuff Tenckhoff catheter is advanced under direct laparoscopic or open vision to the pelvic space — confirmed in the dependent, gravity-dependent position that optimises fluid drainage.
Deep Cuff Anchoring in the Rectus Muscle
The deep Dacron cuff is positioned within the rectus abdominis muscle — the critical anchoring step that secures the catheter against accidental dislodgement and prevents bacteria from tracking along the tunnel toward the peritoneum.
Subcutaneous Tunnel and Exit Site Creation
A subcutaneous tunnel is created from the fascial entry point to the planned exit site, and the superficial Dacron cuff is positioned subcutaneously 2 to 3 cm from the exit — the distance that minimises exit site infection risk.
Flow Testing and Exit Site Dressing
Free inflow and drainage of saline through the catheter is confirmed before closure. The exit site is dressed with the first sterile dressing and PD nursing team instructions on exit site care begin before discharge.
What to Expect
Peritoneal Dialysis Catheter Insertion is performed under general or spinal anaesthesia and takes 45 to 60 minutes. The catheter is introduced into the peritoneal cavity and its position confirmed under direct vision or with laparoscopic imaging, the deep cuff is anchored within the rectus muscle, and the superficial cuff is positioned subcutaneously with the exit site emerging at a comfortable angle for home management. Most patients are discharged within 24 to 48 hours and the first catheter flush is performed within a few days to confirm free flow.
Frequently Asked Questions
Common questions about peritoneal dialysis catheter insertion.
Related Services
Explore other services in our Nephrology department.
Brain Tumour Complex
Haemodialysis Access Surgery
Renal Biopsy
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