PD Catheter Placement and Early Use

In the light of advanced surgical techniques now available there are now few, if any, absolute contraindications to PD, and all patients with advanced CKD who may be candidates for this should be properly counseled and educated about this modality. The challenge of educating the patient should not be the responsibility of the nephrologist alone but should be part of a well-organized multidisciplinary team approach. There are multiple techniques available to place PDCs, including blind percutaneous, open surgical, peritoneoscopic, fluoroscopically guided percutaneous, and laparoscopic insertion. The most common and generally accepted techniques in the United States are fluoroscopically guided percutaneous insertion and laparoscopic assisted insertion. Percutaneous placement is best performed using the modified Seldinger technique with both ultrasound and fluoroscopy guidance, while laparoscopic placement allows more precise tip positioning. With either technique the catheter is tunneled to a convenient and comfortable exit site, at times using extensions to place it in a more distant location. Results are equivalent between techniques and the choice depends upon the resources and skill sets available. Usage is generally delayed by 2 weeks to allow healing, but urgent start PD is a feasible option if needed.