As a nephrologist you want to apply clinical knowledge, skills and aptitudes to solve challenging problems.
Your top priority is treating your patients, and you can make a significant difference by being the direct line between patients who requested PD and those who actually start on it.
The procedure requires significantly fewer health care resources than a surgical insertion.
Instead of waiting to get onto a surgeon’s schedule and having to schedule an OR, your patient receives their PD catheter as an out-patient, under local anesthesia.
Learning the procedural skills and performing the procedure will help you treat many more patients using the modality they wanted and potentially increase the number of patients you serve.
When you refer to surgeons, you may experience delay in initiating PD therapy because of the waiting time to see the surgeon and the time required to arrange the procedure afterwards. By performing the insertion procedure, yourself:
You don’t have to schedule a surgeon or an OR or tie up recovery room and associated hospital staff.
You rely on your own internal scheduling system; you have direct scheduling contact with patients; and you provide ways to prep the patient for the catheter insertion.
You may experience a reduction in complication rates. In some centers using the Seldinger technique, the catheter survival rates were even better than for those implanted by open surgical method in patients who had no prior abdominal surgeries.1,2
The ISPD Guidelines recommend the following clinical pathway:
We recommend a break-in period of at least 2 weeks before elective start on PD (1B)
We recommend a modified PD prescription using low volume exchanges with the patient in the supine position if urgent start on PD with a break-in period of < 2 weeks is needed3
You already know the necessary skills from your medical training: maintaining a sterile field, injecting local anesthetics, making small incisions, using the Seldinger technique, blunt dissecting, and suturing. With this online training and the clinical practice, you can polish and refine those skills and confidently perform the catheter placement.
Setting up a percutaneous PD catheter placement program does not require major changes in the clinic infrastructure. There is no fixed requirement for additional staffing. An equipped procedure room, sterile supplies and catheter kits, and training are generally all that’s needed.
Contraindications for percutaneous placement include previous multiple or major abdominal surgeries, marked central obesity, significant abdominal wall hernias, and the inability of the patient to lay flat or control anxiety.4
CVC can be used immediately, but remains a poor long-term vascular access option due to its higher risk of infection, frequent dysfunction leading to inadequate dialysis therapy.5 Learning how to place a PD catheter percutaneously avoids the downside of having a CVC and offers PD to your patients who chose it.
Medani S, Shantier M, Hussein W, Wall C, Mellotte G. A Comparative Analysis of Percutaneous and Open Surgical Techniques for Peritoneal Catheter Placement. Perit Dial Int. 2012;32(6):628-635.
Özener C, Bihorac A, Akoglu E. Technical survival of CAPD catheters: comparison between percutaneous and conventional surgical placement techniques. Nephrol Dial Transplant. 2001;16(9):1893-1899.
Crabtree JH, Shrestha BM, Chow KM, et al. Creating and Maintaining Optimal Peritoneal Dialysis Access in the Adult Patient: 2019 Update. Perit Dial Int. 2019;39(5):414-436.
Oliver MJ, Crabtree JH. Prioritizing Peritoneal Catheter Placement during the COVID-19 Pandemic: A Perspective of the American Society of Nephrology COVID-19 Home Dialysis Subcommittee [published online ahead of print, 2021 Mar 12]. Clin J Am Soc Nephrol. 2021;CJN.19141220. doi:10.2215/CJN.19141220.
Vachharajani TJ. Dialysis Catheter: "Love-Hate Relationship". Indian J Nephrol. 2018;28(3):185-186.