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Peritoneal Dialysis Access and Exit-Site Care Including Surgical Aspects

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Book cover Nolph and Gokal's Textbook of Peritoneal Dialysis

The key to a successful peritoneal dialysis program is a permanent and safe access to the peritoneal cavity. The catheter should provide optimal and consistent hydraulic function and form a stable interface with the body. A well-healed peritoneal dialysis catheter prevents the periluminal migration of bacteria and leakage of dialysate.

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Notes

  1. 1.

    From French trois (three) + carre (side) = three-sided point, a sharp pointed instrument equipped with a cannula, used to puncture the wall of a body cavity and withdraw fluids.

  2. 2.

    Mushroom or umbrella catheter, a self-retaining bladder catheter, was invented by de Pezzer in 19th century. It had no terminal opening, only lateral openings.

  3. 3.

    Whistle-tip catheter = urethral catheter with a terminal opening as well as a lateral one.

  4. 4.

    Sump drains were double-lumen tubes that allowed air to enter the drained area through the smaller lumen and displace the fluid into the larger lumen. The air sucked back through the larger tube helped to maintain its patency and prevented high negative pressure with consequent suction of adjacent structures into the openings of the large tube. They were used in general surgery and gynecology and in the intraperitoneal space for evacuation of fluid from the peritoneal cavity. The external tubes of sump drains were usually made of a network of stainless steel or brass cords; the internal tubes were solid cannulas.

    Fig. 14.3
    figure 14_3_978-0-387-78940-8

    Continuous peritoneal irrigation. A = 20 L carboy, B = Mandler filter, C = hot plate, D = rubber inflow catheter, E = sump drain, F = suction. Modified from [14]

    Full size image
  5. 5.

    In 1929, Frederick E.B. Foley (1891–1966) developed a catheter for drainage of urine and retained in the bladder by the distensible balloon.

  6. 6.

    Titanium-molybdenum alloy

  7. 7.

    There has been some confusion regarding the terms intermittent and continuous peritoneal dialysis. Some authors applied the term continuous if the lavage was carried on for several days without interruption, and the term intermittent if the lavage was interrupted for a night or a day or two [21]. Others applied the term continuous if peritoneal fluid flowed continuously between the inflow and outflow accesses. In this terminology, intermittent lavage was carried with only one access and the flow was interrupted [2]. Grollman and his colleagues used the term intermittent in the latter meaning, but they performed continuous lavage in the other understanding of this word. To avoid confusion, there was a proposal to use the term continuous peritoneal dialysis regimen for dialysis carried out day and night 7 days per week without interruption and continuous flow peritoneal dialysis technique for the other meaning of this word.

  8. 8.

    Here, by trocar, the authors understood the sheath or cannula of the trocar,

  9. 9.

    Nylon is made of repeating units with amide linkages between them. Hence, it is frequently referred to as a polyamide. Various forms of nylon with various properties are available.

  10. 10.

    0.02 inch = 0.0508 mm

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Authors and Affiliations

  1. University of Oklahoma College of Medicine, Tulsa, Oklahoma

    P. Kathuria

  2. University of Missouri, School of Medicine, Columbia, Missouri, USA

    W.K. Nichols

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  1. P. Kathuria
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  2. Z.J. Twardowski
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  3. W.K. Nichols
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Correspondence to P. Kathuria .

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  1. School of Medicine Department of Medicine Division of Nephrology, MA436 Health Sciences Center, Columbia, MO 65212, USA

    Ramesh Khanna

  2. Academic Medical Center Dept. Medicine, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands

    Raymond T. Krediet

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Kathuria, P., Twardowski, Z., Nichols, W. (2009). Peritoneal Dialysis Access and Exit-Site Care Including Surgical Aspects. In: Khanna, R., Krediet, R.T. (eds) Nolph and Gokal's Textbook of Peritoneal Dialysis. Springer, Boston, MA. https://doi.org/10.1007/978-0-387-78940-8_14

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