Shunt Placement Open vs Percutaneous

Peritoneal dialysis catheters can be placed via an open or percutaneous method. General contraindications to catheter placement include abdominal wall hernias or infections, active inflammatory bowel disease, diffuse intraabdominal adhesions, respiratory insufficiency, and gastrointestinal stomas (11). The Tenkhoff catheter, which is made of Silastic and equipped with two Dacron cuffs, is the most commonly used PD catheter. Placement by the open method is done in the operating room under general or local anesthesia. A small infraumbilical midline incision is used to better allow the catheter to reach into the dependent pelvis. (A supraumbilical incision can be utilized in patients with previous lower abdominal surgery to avoid adhesions.) The abdominal wall fascia is opened, a purse-string suture placed into the peritoneum, and a catheter guide used to direct the catheter toward the pelvis. The purse-string suture is tied down, securing the catheter in position with a watertight seal with the distal Dacron cuff just outside the peritoneum. The proximal end of the catheter is then brought out through a separate small incision site in the abdomen with the proximal Dacron cuff remaining in the subcutaneous tissue helping to secure the catheter in place by fibrosis over time. In the majority of cases, peritoneal dialysis can be instituted immediately.

A laparoscopic approach to catheter placement has also been utilized. This method has the advantage of allowing the guidance of the catheter into proper position in the pelvis under direct vision.

The percutaneous placement of a PD catheter does not require an operating room and can be performed at the bedside or in a treatment room with local anesthesia plus sedation. The peritoneum is instilled with 2-4 L of dialysate via an angiocatheter and a dilator and introducer sheath are inserted into the peritoneal space over a guide wire (12). A Tenckhoff catheter is then directed through the sheath toward the pelvis, and the sheath is pealed away. The proximal end of the catheter is then tunneled subcutaneously, as in the open method, through a separate site.

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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