Perioperative management - Peritoneal dialysis: Open catheter insertion in CAPD - general and visceral surgery
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- End-stage renal disease with planned peritoneal dialysis
- Hemodialysis not possible because of technically insufficient vascular access
Patient not suited for peritoneal dialysis:
- Due to intra-abdominal adhesions or masses
- When proper handling of the catheter is not ensured
Preoperative diagnostic work-up
- Clinical examination: Ruling out any type of hernia
- History of abdominal surgery and inspection of all present scars
- Abdominal ultrasound study: Ruling out malignancies, assessing the size of polycystic kidneys and renal cysts
1 week before surgery
- No more heparin or insulin injections into the abdominal wall, thereby sparing the surgical site and reducing the risk of infection.
Day before surgery
- Standard preparation for surgery
- Enema the evening before the procedure
- Preoperative markup with the patient standing and sitting. Waistband (1), abdominal fold/pendulous abdomen (2), planned catheter exit site (3)
Since the CAPD is performed by the patient the catheter exit site must be easily visible for him/her. Thus, the exit site must not be located at the level of the waistband (outerwear/underwear), in skin folds or below a pendulous abdomen. Since most patients change the dialysate while sitting, the planned catheter exit site should also be checked before surgery with the patient sitting.
Day of surgery
- Single-shot antibiotic (e.g., cefazolin) before anesthesia is initiated
- Possibly Foley catheter for the duration of surgery.
- Injury to the small and large intestines
- Injury of parenchymal organs
- Wound infection, abscess, peritonitis, revision surgery
- Bleeding within the abdominal cavity and/or abdominal wall
- Positioning injuries
Specific catheter complications
- Catheter kinking
- Catheter malposition, leakage, cuff dislocation.
Operating room setup
Special instruments and fixation systems