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What is peritoneal dialysis?

Peritoneal dialysis is a process for filtering the blood by using the thin lining of the belly (peritoneum) and a fluid called dialysate to remove wastes, salt, and extra water from the blood. This is done in sessions, which are called exchanges.

In peritoneal dialysis, these tasks are performed by transferring dialysate to and from the abdomen during each session. The dialysate goes through a peritoneal dialysis catheter that enters the abdomen at the start of each dialysis session, then drains out of the body through the same catheter at the end of each session.

The catheter is small, soft, and easy to conceal. The catheter placement is usually done at least 2 weeks before peritoneal dialysis is started.


Why is it done?

You need dialysis if your kidneys no longer function well enough. Kidney damage generally progresses over a number of years as a result of long-term conditions, such as:

  • Diabetes

  • High blood pressure

  • Kidney inflammation (glomerulonephritis)

  • Multiple cysts in the kidneys (polycystic kidney disease)

What is the benefit of peritoneal dialysis versus hemodialysis?

  • The benefits of peritoneal dialysis compared with hemodialysis include:

  • Greater lifestyle flexibility and independence. These can be especially important if you work, travel or live far from a hemodialysis center.

  • A less restricted diet. Peritoneal dialysis is done more continuously than hemodialysis, resulting in less accumulation of potassium, sodium and fluid. This allows you to have a more flexible diet than you could have on hemodialysis.

  • Longer lasting residual kidney function. People who use peritoneal dialysis might retain kidney function slightly longer than people who use hemodialysis.

  • Peritoneal dialysis may be the better option if you:

  • Can’t tolerate the rapid changes of fluid balance associated with hemodialysis

  • Want to minimize the disruption of your daily activities

  • Want to work or travel more easily

  • Have some residual kidney function

  • Peritoneal dialysis might not work if you have:

  • Extensive surgical scars in your abdomen

  • A large area of weakened abdominal muscle (hernia)

  • Limited ability to care for yourself, or a lack of caregiving support

  • Inflammatory bowel disease or frequent bouts of diverticulitis

  • Talk with your kidney doctor about if peritoneal dialysis is for you. Factors to consider include:

  • Your kidney function, overall health, personal preferences, home situation, and lifestyle

What are the risks?

Complications of peritoneal dialysis can include:

  • Infections. An infection of the abdominal lining (peritonitis) is a common complication of peritoneal dialysis. An infection can also develop at the site where the catheter is inserted to carry the cleansing fluid (dialysate) into and out of your abdomen. The risk of infection is greater if the person doing the dialysis isn’t adequately trained.

  • Weight gain. The dialysate contains sugar (dextrose). Absorbing some of the dialysate might cause you to take in hundreds of extra calories daily, leading to weight gain. The extra calories can also cause high blood sugar, especially if you have diabetes.

  • Hernia. Holding fluid in your abdomen for long periods may strain your muscles.

  • Inadequate dialysis. Peritoneal dialysis can become ineffective after several years. You might need to switch to hemodialysis.

If you have peritoneal dialysis, you’ll need to avoid:

  • Certain prescription and over-the-counter medications that can damage your kidneys, including nonsteroidal anti-inflammatory drugs.

  • Soaking in a bath or hot tub, or swimming in a lake, pond, river or non-chlorinated pool — which increases the risk of infection. Showers and swimming in a chlorinated pool are generally acceptable

How is the peritoneal dialysis catheter placed?

The procedure is performed at El Camino Hospital in the catheterization lab also known as the “cath lab.” An entire team will be taking care of you during the procedure including a radiology nurse, a radiology technologist and the physician. In the procedure room, the nurse will help you lay on an exam table. You will be connected to heart rate, blood pressure and oxygen saturation monitors. Medicine may be given to relax you through your IV called moderate, also known as “twilight,” sedation. Your procedure area will be prepped and sterilized. A numbing medicine will be injected into the area (local anesthetic). Using x-ray (fluoroscopy) guidance, the peritoneal cavity will be visualized a small puncture will be made through the skin, into the abdomen and peritoneal space. A guidewire will then replace the needle and the needle will be removed. Another puncture will be made a couple inches from the guidewire and the dialysis catheter will be tunneled just under the skin to the guidewire. This tunneling helps anchor the catheter in place. The dialysis catheter will then go over the guidewire into the abdomen and the guidewire is removed.  The tube exiting your skin will be temporarily sutured in place and your initial puncture site will be sutured closed.  After completion, your dialysis catheter and procedure site will be securely dressed and bandaged with a water sealed dressing.

The procedure time usually takes about 15-30 minutes. Throughout the procedure, medication is given through your IV to keep you comfortable. Your oxygen saturation, blood pressure and pulse are checked closely during and after the procedure.

What can you expect after the procedure?

After the procedure you will go to the post surgical area for recovery where we will be able to monitor your vital signs and the site of the procedure. In general, you will be there for about 1 hour. We want to be sure you do not have any problems before you go home.

You will be able to eat and drink right after the procedure. You also will be able to see your family members soon after the procedure. If you feel well enough, you will be able to go home.

At home, we recommend that you take it slow the remaining day of the procedure. You should not drive, operate heavy machinery or consume alcohol until the following day after the procedure, if you received sedation.

We recommend you follow-up the next week to check your procedure site.

How long does it take to recover?

Most patients should be able to return to their normal activities the day after the procedure.

We recommend no contact sports or extraneous activity for a period of approximately 1-2 weeks post procedure to minimize the chance of bleeding.

When can I start using my peritoneal dialysis catheter?

We wait at least 1 month after placement of your dialysis catheter to ensure proper healing. After 1 month, it is up to your kidney doctor when you can start peritoneal dialysis.

Can I take a shower with the catheter in place?

Yes. Initially it should be covered with plastic. However, after 2 weeks you can get the site wet. After the contact with the water, the tube site should be dried off with a towel and a new dressing should be applied.

General Instructions:

  • If you received sedation, you should not drive, consume alcohol, operate heavy machinery or make any important decisions for the remainder of the day.

  • You may resume your regular activities (including driving) after 24 hours, unless you have been restricted for another reason.

  • No exercising, lifting heavy objects or strenuous activity for the next 24 hours.

  • You may shower 24 hours after the procedure.

Pain Management
  • You may use over the counter medication such as Acetaminophen (Tylenol) or ibuprofen (Advil /Motrin) for minor discomfort, unless you are restricted from taking these medications.

  • If you feel that Tylenol or Advil are not enough for pain control, please contact the Vascular and Interventional Radiology Clinic at (650)404-8445.

  • While this is controversial, no one really has a good reason why you cannot shower with your peritoneal dialysis catheter. So we suggest that you do NOT shower the day of the procedure, but can shower the next day as long as you try to keep the catheter insertion site covered and dry while you shower for the first two weeks. During this time you should not soak the catheter or the insertion site in water (eg. bath and swimming pool). 

  • During the first 2 weeks you should cover your dialysis catheter with a watertight seal/dressing while you take a shower. 

  • After 2 weeks the catheter site should be adequately healed, so if it gets wet it should not be a problem. Just be sure to blot the site dry and place a new dressing.

  • If the dressing gets wet during shower, dry the area around the catheter and apply a new dressing.

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