Peritoneal Dialysis Catheter Insertion

Peritoneal Dialysis Catheter Insertion: Placement of a Tenckhoff catheter in the abdomen

Why do I need a Tenckhoff Catheter?

Your doctor has recommended, on the basis of your blood results and how you are feeling, that you need to start dialysis treatment for kidney failure. You have opted for peritoneal dialysis.

The peritoneum is a natural membrane that lines the organs in the abdomen (tummy area). In Peritoneal Dialysis (PD) it is used as a filter, to clean the blood, when your kidneys are no longer performing well enough to keep you healthy. In order to do this, a permanent tube known as a Tenckhoff Catheter needs to be placed in the lower part of your belly. This is used to run in and drain out dialysis fluid. This soft, flexible tube lies flat against your body. There is no opening and no odour.

In the ‘manual’ system, known as CAPD (Continuous Ambulatory Peritoneal Dialysis), the fluid is left in your abdomen to do the dialysis for several hours and then drained out, taking with it some of the waste products and excess water normally removed by the kidneys. Fresh fluid is then run into the abdomen. This exchange of fluid is repeated 3 or 4 times during the day and takes about 30 minutes each time.

The fluid comes in a range of volumes and ‘strengths’; these remove different amounts of excess water, depending on your individual and changing needs.

At Southmead Hospital, the catheter is inserted by a surgeon in an operation that is usually carried out under general or local anaesthetic. Both are day case procedures.

Where will the catheter be positioned?

Matters to consider:

  • Where do the waistbands on your clothes and underwear sit? You do not want these to be on top of your tube or exit site as this may interfere with healing.
  • Which side do you prefer to sleep on (if any)? You do not want the tube to come out on that side as it may be uncomfortable and may interfere with healing.
  • Where are the natural skin folds when you are sitting? The exit site should not be in a fold.

You will have the opportunity to discuss these issues with your surgeon before the operation, and the agreed site will be marked on your skin.

How will I be prepared for the procedure?

Infection screening

Before the procedure is carried out, you will have swabs taken of your nose and groin, to check whether you are carrying any bacteria on your skin surface that could cause infection of the catheter. If the swabs are positive, you may need to have some treatment to clear the bacteria before the procedure can be carried out.

The usual treatment is:

  • Cleaning your skin with an antibacterial wash – Hibiscrub or Octenisan – for 5 days before the procedure takes place.
  • Applying an antibacterial ointment – Mupirocin or Naseptin – to both nostrils three times a day for 5 days before the procedure takes place.

You will get a leaflet with full instructions when you are given the medications to take home. If for any reason you have not had these tests done in advance of the procedure, they will be done when you are admitted and if treatment is required it will be started then (the treatment still needs to last for 5 days).

Medications

If you take warfarin, clopidogrel or other blood-thinning tablets, you will need to stop taking these before the procedure is carried out. Your doctor or pre-operative assessment clinic (POAC) nurse will advise exactly when to stop taking these tablets.

What happens before the operation?

General Anaesthetic - you will be given a date to attend the pre-operative assessment clinic (POAC) in preparation for your surgery. Some blood samples will be taken and swabs along with measurements of your blood pressure, pulse, temperature and oxygen level.

Local Anaesthetic - bloods and swabs will be taken on initial visit.

A member of the renal community team will come to your house and visit you to go through the practicalities of peritoneal dialysis, including:

  • Storage of dialysis fluids
  • Ordering stores and delivery
  • Area where you will do peritoneal dialysis
  • Hand washing technique and cleanliness
  • List of instructions for how to keep the tube safe when you get home after the operation

You will be given a date for your surgery. It is important to have your bowels well open before the operation. You will be asked to take laxatives called Sodium Docusate and Senna 3 days before the operation.

You will continue to take laxatives after the operation which will ensure that the PD tube inside you will not move because of constipation. Constipation can push the PD tube into the wrong place, which can cause a PD fluid drainage problem.

What happens on the day of the operation?

General Anaesthetic – you will attend the medirooms

Local Anaesthetic – you will attend renal ward 8B

If your operation is planned for the morning, you will not have anything to eat or drink after 12 midnight. If your operation is in the afternoon, you will be given an early breakfast at about 6am, and then nothing to eat or drink after that. If you have diabetes that is treated with medication, it is essential that you inform the nurses of this.

You will be given an antiseptic solution to shower with, and then have a clean theatre gown and anti-embolism compression stockings to put on.

Please be aware that we cannot give you an exact time for your operation, as theatre lists need to be flexible to deal with any emergencies that may occur. Everything possible will be done to ensure that you are not kept ‘Nil By Mouth’ any longer than is necessary.

Please do NOT bring any valuables or large amounts of cash in with you as we cannot be responsible for them.

A member of renal community team will see you before the procedure to mark the position of the PD tube exit site.

You will be asked to sign a consent form. The surgeon who is to carry out the procedure will explain what you should expect, including the reasons for the catheter being inserted and possible complications that can occur, to be sure you are aware of these.

What happens after the operation?

When you have recovered from the anaesthetic, you will be given painkillers if you need them. You will be encouraged to eat and drink as soon as you feel like it.

If you have had a general anaesthetic, you will have blood tests to check your kidney function and haemoglobin level. There will be dressings on your abdomen and you will have a stitch (suture) in place, closing the exit site. This may be the sort of suture that dissolves, but if not it will be removed about 10 days after your operation.

You are likely to have some bruising on your abdomen after the operation.

You will be able to go home on the same as day as the operation in most cases. You will be given phone numbers to ring should you have any problems.

What immediate follow-up care will I receive?

On the following day after the operation, a member of the renal community team will call you to check your recovery and give you a date to attend for a check-up. This will happen 7 days after your operation. We will check your wound and flush the PD tube to check patency.

At this appointment, information will be given about the PD training, stores delivery and ongoing care. 2 or 3 weeks after your operation, PD training will take place. Training is carried out in your home and normally takes 3 days.

2 or 3 weeks after the training, you will attend PD clinic to check your progress.

Will I need to take time off work?

Most patients are advised to take 7 days off work to recover from the procedure. Some people need more than this and some people need less. If you have a manual job, you are more likely to need more time off.

What complications might occur?

There are four main possible complications that could occur with this procedure:

Functional problems

Occasionally, the catheter may not work despite apparently successful insertion. This may be due to the tip of the catheter sitting in the wrong place, or getting covered by internal tissue, which stops it working. At this unit, this occurs in less than 7 per cent of insertions (fewer than 7 in every 100 insertions).

Bleeding

Bleeding may occur, mostly as a result of bruising around the wound, and it usually stops of its own accord. In fewer than 1 in 100 insertions (less than 1 per cent), you may need to have more surgery to stop the bleeding.

Infection

You will be given intravenous antibiotics at the time of the catheter insertion to prevent infection. Despite this, some patients develop infection at the catheter exit site, which requires treatment with a further course of antibiotics. This occurs in less than 1 per cent of insertions (less than 1 in every 100 done).Very occasionally this may require the catheter to be removed.

There is also a risk of infection developing deeper in the abdomen, causing peritonitis in the immediate post-op period (the first two weeks after insertion). At our unit, this occurs in around 3 per cent of insertions, and will be treated with different antibiotics.

Bowel perforation

Very occasionally during the course of the procedure, the bowel is cut by mistake. This occurs in fewer than 1 in 100 insertions (i.e less than 1 per cent). This is a serious complication that may require a surgical operation and an inpatient stay in hospital.

How will I be looked after in the long term?

A Community Team Nurse will be allocated to look after your ongoing care and he or she will keep in contact with you. This will involve some visits to your home.

A follow-up clinic appointment will be arranged with one of the renal doctors after training.

Hospital transport can be provided for all your hospital appointments and training, if necessary, but we do encourage you to make your own arrangements if at all possible.

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.

How to contact us:

Renal Community Team
Level 1, Gate 5
Brunel building
Southmead Hospital
BS10 5NB

0117 414 8004

renalcommunityteam@nbt.nhs.uk

© North Bristol NHS Trust. This edition published October 2020. Review due October 2022. NBT002131

Peritoneal Dialysis Catheter Insertion