Peritoneal dialysis catheters

Your belly is lined by a thin, smooth membrane called the peritoneum. It has many tiny blood vessels. In peritoneal dialysis (PD), a cleaning fluid called dialysate flows into your belly through a catheter and rests there for a few hours. Waste, salt and extra water pass from your blood into the fluid, and then you drain it out and replace it with fresh fluid. Each cycle is called an exchange.

You can do exchanges by hand several times a day, or use a machine called a cycler that does them while you sleep. Either way, PD is done at home after a few weeks of training with a PD nurse. The catheter is the key: a soft silicone tube, about as wide as a pencil, with one end coiled inside the belly and the other end coming out through the skin, usually below and to the side of the belly button.

On X-ray, the catheter shows as a thin line running down through the belly wall, with its curled tip resting low in the pelvis, the lowest part of the belly where the fluid collects.

Both types of dialysis work well. The right choice depends on your health, your home, and how you want to live. Your kidney doctor helps you decide.

Before placement, you meet with your kidney team and PD nurse, who help choose the best exit site, away from your belt line and skin folds. We review your past surgeries and may look at a recent scan. If you have had major belly surgery, a surgeon may place the catheter with a camera (laparoscopy) instead.

The procedure is done at El Camino Hospital in the interventional radiology suite, with a nurse, a radiology technologist and your interventional radiologist. We monitor your heart rate, blood pressure and oxygen the whole time. You receive an antibiotic through your IV to lower the chance of infection.

1. 1
   Relax and numb

   You receive moderate sedation through your IV. We clean the belly and numb the skin and the deeper layers of the belly wall.

2. 2
   Enter the belly safely

   Using ultrasound and X-ray, we pass a small needle through the belly wall into the space inside, then confirm the position with a little contrast dye and place a guidewire.

3. 3
   Place and tunnel the catheter

   The catheter is guided into the lowest part of the belly. Its inner fabric cuff sits in the muscle of the belly wall, and the outer end is tunneled a few inches under the skin to the exit site, where a second cuff sits just beneath the skin.

4. 4
   Test and dress

   We run fluid in and out to confirm it flows well, close the small incision, and cover the exit site with a sterile dressing.

Placement usually takes about 30–45 minutes. You rest in recovery for about an hour and can eat and drink before going home.

The catheter needs time for the tissue to grow into its cuffs and seal the tunnel. Using it too early for full exchanges can cause leaks. We usually wait at least 2–4 weeks before full-volume PD begins, and your kidney team decides the exact start date. During this break-in period, your PD nurse flushes the catheter about once a week to keep it open.

1. First day
   Rest at home. No driving, alcohol or important decisions until the next day because of the sedation. Mild belly soreness is normal; acetaminophen (Tylenol) helps.
2. First week
   Leave the dressing on and keep it dry. Take sponge baths or shower with the site fully covered. We see you about a week later to check the site.
3. Weeks 1–2
   Avoid heavy lifting, straining, and contact sports, which strain the healing belly wall. Keep your bowels moving.
4. Weeks 2–4
   PD training usually begins. Once healed, you can shower with the exit site uncovered, then pat it dry and put on a clean dressing.
5. Long term
   Clean the exit site daily as your PD nurse teaches. Keep the catheter taped so it does not pull. No baths, hot tubs, or swimming in lakes, rivers or the ocean.

Over years, the peritoneum can become less efficient, and some people switch to hemodialysis. The dialysate contains sugar, which can add calories and raise blood sugar, so your team will watch your weight and diabetes control.

Before a PD catheter, I use ultrasound to look at the belly wall and plan a path that avoids blood vessels and loops of bowel, and I talk with you about where you wear your belt, because the exit site should sit where you can see it and keep it clean. I tell patients that constipation is the enemy of a PD catheter. A lot of catheters that seem broken start working again once the bowels are moving.

Fabio Komlos, MD, interventional radiologist · About Dr. Fabio Komlos