Dr Jason Toniolo

Peritoneal Dialysis Catheters

A peritoneal dialysis catheter is also known eponymously as a Tenckhoff catheter. It is a tube placed into the abdomen to allow for peritoneal dialysis, an alternative to hemodialysis for patients with kidney failure.

The peritoneum is a shiny layer within the envelope that wraps the entire intestines and many abdominal organs like an envelope. Everyone has this shiny layer. It can be used as a filter to wash the blood of waste products, a job usually done by the kidneys.

How peritoneal dialysis works

During peritoneal dialysis, a fluid is pumped into the abdomen through the peritoneal dialysis tube. This fluid is known as dialysate. It attracts fluid and waste products from the blood and accumulates in the peritoneal compartment with the dialysate. Then, the large volume of fluid, which is now rich in waste products, is sucked out of the abdomen again through the peritoneal dialysis catheter, washing the blood of the waste products.

What are the differences between haemodialysis and peritoneal dialysis?

The dialysis nursing team will discuss the differences at length with you. They have abundant experience explaining and directing each patient towards the dialysis access route best suits their lives and personalities. 

Who is not suitable for a peritoneal dialysis catheter insertion?

Patients who have had extensive abdominal surgery are generally unsuitable for PD catheter insertion. The amount of scar tissue within their abdomen dramatically increases the risk of injury from catheter insertion and malfunction when inserted. It can be done, but it is not advisable unless necessary.

treatment options

How is the peritoneal dialysis catheter surgery done?

  1. Before the operation, a dialysis nurse will mark your abdomen for the best spot for the dialysis catheter to come out of your tummy so that you can easily reach it.
  2. You come into the hospital operating theatre and are placed under general anaesthesia
  3. There is a small cut made below the belly button in the midline, and your surgeon will make a 1cm cut in your peritoneum
  4. The catheter is inserted into the peritoneal cavity to sit just behind your bladder
  5. An x-ray is taken to ensure the position is appropriate
  6. Fluid is infused into the abdomen and then evacuated immediately after to ensure it is functioning well
  7. The catheter is secured to the peritoneum with some stitches to make the peritoneum water-tight around the catheter
  8. The catheter is tunnelled under the skin for a few centimetres and then pierces your skin to the right or the left of the midline, above the belt line, but below the belly button for easy access.
  9. You will stay overnight in hospital and then go home the next day
  • Dialysis nurses will review your wound and teach you how to do peritoneal dialysis in the hospital when you commence so that you can do it at home on your own in the future

Risks of peritoneal dialysis catheter

The risks are small, but all surgery has significant risks

  1. Risk of injury to the intestines – it happens infrequently, but rarely, the intestine can be injured when the peritoneal dialysis catheter is inserted
  2. Infection (3%) – Infection usually occurs within the first two weeks but can occur at any time in the future after the catheter is inserted. An infected catheter must be removed, as antibiotics will not clear the bugs off of the catheter
  3. Migration or obstruction of the catheter (10%) – The catheter can sometimes move in the months following its insertion; it is no longer sitting in the optimal position to drain all the fluid in your abdomen or stops working altogether. It may need to be re-positioned
  4. Leak around the catheter (3%) – Sometimes, if dialysis is commenced too soon after the tenckhoff has been put in, the seal of the peritoneum around the catheter isn’t waterproof enough. Fluid can leak into the space above the peritoneum but below your skin. Catheter leakage is rarely a significant problem, as it will get reabsorbed, but it can increase infection risk and means the catheter should not be used for two weeks