Continuous AmbulatoryContinuous Ambulatory
Peritoneal Dialysis TechniquePeritoneal Dialysis Technique
Dr/Amir SiddigDr/Ami...
IntroductionIntroduction
• Peritoneal dialysis (PD) as a treatment for
ESRF started in1959 .
• Rigid catheters were used w...
• Coupling Tenckhoff catheter with the
cycling device made by Norman Lasker
home IPD program started in 1970
• Monchrieff ...
Types of catheterTypes of catheter
Implantation MethodsImplantation Methods
1. Open Method
2. Blind Method
3. Laparoscopy
1.1. Open MethodOpen Method
• Direct dissection of abdominal layers and
peritoneum under vision .
• Deep cuff secured with...
2- Blind (subcutaneous) Method2- Blind (subcutaneous) Method
• The catheter is inserted blindly over a
needle ( Seldinger ...
3- Laparoscopy3- Laparoscopy
• Provides excellent visualization of the
entire abdominal cavity
• Proper placement of the c...
Pre-Operative AssessmentPre-Operative Assessment
1. Exclude active skin or systemic infection
2. Inspect for old scars and...
4-Shave abdominal hair.
5-Empty bladder and bowel.
6-Use prophylactic antibiotics prior to the
procedure.
AnaesthesiaAnaesthesia
• General anaesthesia (GA) is not
recommended and should be avoided
whenever possible -ESRF patient...
• The maximum recommended dose :
Lidocaine without epinephrine=3mg/Kg
Lidocaine with epinephrine =7mg/Kg
• Gentle handling...
The ProcedureThe Procedure
• Monitor HR and SPO2 and get a peripheral
venous line
• Give prophylactic intravenous antibiot...
• Make 2-3 cm longitudinal incision starting 1 cm
below the umbilicus
• Infiltrate more LA for the linea alba as it is
exp...
• Grasp the parietal peritoneum with two
artery forceps after palpation to avoid catching
bowel
• Open the peritoneum unde...
• Approximate the muscles
• Close the anterior rectus sheath (linea
alba) meticulously with prolene or nylone
no 1
• Give ...
• Puncture the exit site and pull the catheter by a
forceps inserted through the exit wound so that
the superficial cuff w...
Postoperative CarePostoperative Care
1. Dressing is only changed if it becomes
soaked or after one week.
2. Strict aseptic...
ComplicationsComplications
1. Intra-abdominal injuries.
2. Dialysate leaks.
3. Catheter malposition and migration.
4. Cath...
Thank You
Continuous Ambulatory Peritoneal Dialysis Insertion Technique
Continuous Ambulatory Peritoneal Dialysis Insertion Technique
Continuous Ambulatory Peritoneal Dialysis Insertion Technique
Continuous Ambulatory Peritoneal Dialysis Insertion Technique
Continuous Ambulatory Peritoneal Dialysis Insertion Technique
Continuous Ambulatory Peritoneal Dialysis Insertion Technique
Continuous Ambulatory Peritoneal Dialysis Insertion Technique
Continuous Ambulatory Peritoneal Dialysis Insertion Technique
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Continuous Ambulatory Peritoneal Dialysis Insertion Technique

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guidance how to insert a PD catheter

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Continuous Ambulatory Peritoneal Dialysis Insertion Technique

  1. 1. Continuous AmbulatoryContinuous Ambulatory Peritoneal Dialysis TechniquePeritoneal Dialysis Technique Dr/Amir SiddigDr/Amir Siddig Department of SurgeryDepartment of Surgery Ribat University HospitalRibat University Hospital
  2. 2. IntroductionIntroduction • Peritoneal dialysis (PD) as a treatment for ESRF started in1959 . • Rigid catheters were used with frequent punctures(IPD) . • Problem of maintaining access for chronic dialysis. • Henry Tenckhoff developed home fluid production machine and the soft silicone catheter in 1963.
  3. 3. • Coupling Tenckhoff catheter with the cycling device made by Norman Lasker home IPD program started in 1970 • Monchrieff and Popvich developed the program of Continuous Ambulatory Peritoneal Dialysis (CAPD) in 1975 in response to patients with no vascular access
  4. 4. Types of catheterTypes of catheter
  5. 5. Implantation MethodsImplantation Methods 1. Open Method 2. Blind Method 3. Laparoscopy
  6. 6. 1.1. Open MethodOpen Method • Direct dissection of abdominal layers and peritoneum under vision . • Deep cuff secured within rectus sheath • Limited exposure of peritoneal cavity
  7. 7. 2- Blind (subcutaneous) Method2- Blind (subcutaneous) Method • The catheter is inserted blindly over a needle ( Seldinger technique) • Possible risk of perforation of bowel and mesentery-No visualization of abdominal cavity (against surgical principles) • The deep cuff is placed outside abdominal musculature
  8. 8. 3- Laparoscopy3- Laparoscopy • Provides excellent visualization of the entire abdominal cavity • Proper placement of the catheter tip in pelvic cavity and the deep cuff within the abdominal musculature • Requires expensive equipment and advanced training for doctors
  9. 9. Pre-Operative AssessmentPre-Operative Assessment 1. Exclude active skin or systemic infection 2. Inspect for old scars and skin folds 3. Determine the exit site: -Avoid bony prominences and belt line -Should be appropriate and accessible for the patient. -Mark the exit site with indelible marker
  10. 10. 4-Shave abdominal hair. 5-Empty bladder and bowel. 6-Use prophylactic antibiotics prior to the procedure.
  11. 11. AnaesthesiaAnaesthesia • General anaesthesia (GA) is not recommended and should be avoided whenever possible -ESRF patients have altered metabolism and excretion of anaethetics • Local anaesthesia(LA) in the form of Lidocaine 1% or 2% with or without epinephrine is adequate.
  12. 12. • The maximum recommended dose : Lidocaine without epinephrine=3mg/Kg Lidocaine with epinephrine =7mg/Kg • Gentle handling and retraction is essential to reduce pain and discomfort . • The patient should have a venous access , HR and SPO2 monitoring. • Resuscitation facilities should be available.
  13. 13. The ProcedureThe Procedure • Monitor HR and SPO2 and get a peripheral venous line • Give prophylactic intravenous antibiotic (Cefazoline) • Prepare the skin with antiseptic and drape • Expose prei-umblical area and exit site • Use LA in adequate dosage –dilute with saline • Infiltrate LA in the skin and subcutaneous tissue down to linea alba. • Wait for 2 minutes for the anaesthesia to be profound and test for pain.
  14. 14. • Make 2-3 cm longitudinal incision starting 1 cm below the umbilicus • Infiltrate more LA for the linea alba as it is exposed and also infiltrate the recti on each side of the wound • After incising the linea alba , gently retract the recti to expose the posterior rectus sheath and parietal peritoneum • Give further doses of LA for the parietal peritoneum
  15. 15. • Grasp the parietal peritoneum with two artery forceps after palpation to avoid catching bowel • Open the peritoneum under direct vision • Place the catheter tip with the help of a long artery forceps low in the left side of the pelvic cavity –warn the patient that this step may cause some discomfort • Test the patency of the catheter • Fix the deep cuff to the posterior rectus sheath with 2/0 prolene
  16. 16. • Approximate the muscles • Close the anterior rectus sheath (linea alba) meticulously with prolene or nylone no 1 • Give LA at the exit site and the tunnel • Create a subcutaneous tunnel using an artery forceps or a tunneler.The recommended subcutaneous tunnel is slightly arcuate and directed downwards
  17. 17. • Puncture the exit site and pull the catheter by a forceps inserted through the exit wound so that the superficial cuff will be placed within the subcutaneous tissue just deep to the exit wound. • No need to fix the catheter at the exit site • Test filling and drainage. • About 250 ml may be left inside the abdominal cavity – this may prevent omentum and debris from blocking the catheter.
  18. 18. Postoperative CarePostoperative Care 1. Dressing is only changed if it becomes soaked or after one week. 2. Strict aseptic technique in dressing. 3. Shower is allowed after two weeks. 4. Keep the catheter immobilized to the skin. 5. Avoid constipation.
  19. 19. ComplicationsComplications 1. Intra-abdominal injuries. 2. Dialysate leaks. 3. Catheter malposition and migration. 4. Catheter obstruction and poor drainage. 5. Incisional and inguinal hernia. 6. Pain. 7. Infection –peritonitis.
  20. 20. Thank You
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