Complications - Peritoneal dialysis: Open catheter insertion in CAPD

Injury to abdominal organs

• Careful opening of the abdominal cavity under direct view
• Careful insertion of the catheter

Bleeding

• Blunt dissection of the rectus muscle

In general, careful dissection technique is rarely fraught with intra-operative complications. When in doubt enlarge the access.

Secondary bleeding

• Compression dressing, possibly revision surgery

Peritonitis

• Laparoscopy, possibly laparotomy

Wound infection

• Open wound care

Kinking

• Kinking can be avoided by careful tunneling and inspection of the cuff position with the anterior lamina of the rectus sheath still open.

Catheter malposition, leakage

• Catheter malposition should primarily be avoided, or detected early, by intraoperative fluoroscopy.
• Secondary catheter malposition generally calls for laparoscopic repositioning attempts under general anesthesia.
• Recurrent catheter malposition after successful repositioning might require completely new insertion of the catheter. To correct catheter malposition, in a few of our cases we successfully fixated the catheter in the pouch of Douglas by absorbable suture.
• In leakage attempted nonsurgical treatment with bed rest and temporary stop of catheter usage may be successful. If unsuccessful this requires revision surgery.

Infection of the abdominal wall, tunnel infection

• Tunnel infection may initially be treated nonsurgically (antibiotic regimen by sensitivity testing, mechanical tunnel cleansing by irrigation)
• Single-step catheter replacement is indicated whenever persistent infection cannot be controlled by nonsurgical means
• In catheter replacement, the new catheter should always be inserted on the contralateral side.