Catheter Insertion and Care

Perioperative and Intraoperative Management

Preoperative Management

Preoperative Management

Review the recommended actions and processes for your facility and patient prior to the catheter insertion procedure.

Perioperative and Intraoperative Management

Perioperative and Intraoperative Management

Explore more on the percutaneous PD catheter insertion technique.

Postoperative Management

Postoperative Management

Recap on the post-procedure activities associated with preparing your patient for discharge after PD catheter insertion.

Perioperative and Intraoperative Management

Perioperative and Intraoperative Management

  • Successful peritoneal access is crucial and should be performed by an operator (surgeon, specialist nurse, or physician) with training and expertise in creating peritoneal access.1
  • The choice of PD Catheter implantation approach should be based upon patient factors, facility resources and operator expertise.2

PD: Peritoneal Dialysis

Key Assessments

Perioperative and Intraoperative Management

Verify completion of preoperative activities

  • Patient had fasted as per hospital protocol.
  • Shower on day of surgery with chlorhexidine soap.3
  • Emptied bladder or use of Foley catheter.4,5 
  • Completion of bowel preparation.4,5 
  • Appropriate exit-site marking.3

Best Practices in Patient Preparation and Peritoneal Catheter Implantation

Perioperative and Intraoperative Management

A. Prepare Patient

  • Administer a single preoperative prophylactic antibiotic to provide anti-staphylococcal coverage.2,6,7
  • If hair removal is necessary, electric clippers should be used.4
Perioperative and Intraoperative Management

B. Prepare Catheter

  • Eliminate air from catheter cuffs prior to implantation by soaking and gently squeezing cuffs in saline solution.3
Perioperative and Intraoperative Management

C. Catheter Insertion

  • Methods of catheter insertion includes laparoscopic, laparoscopic-assisted, open dissection, and percutaneous needle-guidewire with or without image guidance.2
  • Double cuff catheter must be preferred to use.8
Perioperative and Intraoperative Management

  • The catheter is inserted via the paramedian approach through the rectus muscle with a deep catheter cuff within or below it.3
  •  Catheter tip should be placed in the pelvic location.3
  • At the peritoneum and anterior/posterior rectus sheath level, purse-string suture(s) should be placed around the catheter.2
Perioperative and Intraoperative Management

  • Exit site must be located ≥2 cm beyond superficial cuff directed lateral or downward.2
  • Smallest exit site hole should be made on the skin to pass the catheter.2
  • No anchoring suture at exit site.2
Perioperative and Intraoperative Management

D. Verify catheter function

  • Catheter patency and flow must be tested before tunneling of the catheter and prior to final closure during the surgical procedure.2
  • Catheter position should be revised until satisfactory flow function is achieved before the procedure ends.2
Perioperative and Intraoperative Management

E. Final catheter preparation

  • Attach dialysis unit’s requested catheter adapter and transfer set at the time of procedure.2
  • Exit site protected and catheter immobilized by non-occlusive dressing.9

Patient education

Perioperative and Intraoperative Management

  • Review postoperative instructions prior to patient discharge
  • Provide written instructions regarding follow-up care
  • Review postoperative medications and postoperative pain management
  • Schedule the follow-up of the patient weekly