What Is an Intraperitoneal Catheter?

The peritoneal dialysis tube is composed of a catheter, a lead wire and a nylon sleeve. The insertion end of the catheter is provided with a side hole, which is characterized in that the insertion end is provided with two arms in a Y shape and the angle between the two arms is 40 °. Peritoneal dialysis is an effective renal replacement therapy for end-stage renal disease, and peritoneal dialysis catheters are the "lifeline" for patients with peritoneal dialysis.

The peritoneal dialysis tube is composed of a catheter, a lead wire and a nylon sleeve. The insertion end of the catheter is provided with a side hole, which is characterized in that the insertion end is provided with two arms in a Y shape and the angle between the two arms is 40 °. Peritoneal dialysis is an effective renal replacement therapy for end-stage renal disease, and peritoneal dialysis catheters are the "lifeline" for patients with peritoneal dialysis.

Chinese name

Peritoneal dialysis tube

Foreign name

Peritoneal Dialysis Catheter

Management category

Class II medical devices

Category Name

Body fluid processing equipment

Classification of peritoneal dialysis tubes

There are four commonly used peritoneal dialysis tubes in clinic, which are Tenck-hoff straight tube, curl tube, Swan-neck straight tube, and Swan-neck curl tube. ^[1]

Implantation of peritoneal dialysis tube

There are three traditional catheterization methods: open surgical catheterization, direct puncture or guide wire guided puncture, and laparoscopic catheterization.

Open surgical catheterization

Surgical open anatomical peritoneal dialysis catheterization is the most common method for peritoneal dialysis catheterization in patients with end-stage renal disease because of its simple operation, no special equipment and general anesthesia, and low risk of intestinal perforation and bleeding.

2. X-ray peritoneal dialysis puncture catheter

In 2014, the International Society of Peritoneal Dialysis released the best practice guidelines for percutaneous puncture and peritoneal dialysis catheterization. Under the guidance of X-ray fluoroscopy, a guide wire was inserted into the pelvic cavity through the percutaneous puncture Seldinger technology, and then a sheath was placed along the guide wire Tube, peritoneal dialysis catheter is placed into the pelvic cavity through the sheath, and the rest of the steps are the same as surgical peritoneal dialysis. The advantages of this method are minimally invasive, economical, and easy to operate. It avoids the disadvantages of blind insertion in open surgery. It is suitable for patients who need urgent peritoneal dialysis treatment, and because of its simplicity and ease, it is suitable for physicians and interventional surgeons to perform operation catheterization. .

3. Laparoscopic peritoneal dialysis catheterization and fixation

According to whether the distal end of the peritoneal dialysis tube is fixed in the abdominal cavity, laparoscopic peritoneal dialysis catheterization can be divided into fixed and non-fixed. Fixed laparoscopic tube placement can be divided into end-fixation method, abdominal wall suspension method and stealth tunnel method according to different fixation methods. With the advantage of visualization operation, after the laparoscopic suture is passed through the distal end of the peritoneal dialysis tube with a needle suture, the suture is knotted under the microscope, and the distal end of the peritoneal dialysis tube is sutured in the pelvic cavity. The fixation site can be selected from rectal bladder depression, uterine rectal depression (Douglas's fossa), uterine round ligament, parietal peritoneum on umbilical cord, lateral peritoneum of pelvis, bladder or posterior uterus. The abdominal wall suspension method uses a puncture needle with a slightly larger inner diameter to fold a suture in half, and places the closed end of the suture into the abdominal cavity through the puncture needle core, so that it forms a closed ring on the inner wall of the abdominal cavity. Then adjust the position of the peritoneal dialysis tube so that the distal end passes through the ring, remove the puncture needle and tie it under the skin, and finally fix the peritoneal dialysis tube to the front abdominal wall. The subterranean tunnel catheterization method is mainly to submerge the peritoneal dialysis catheter in the superficial layer of the rectus abdominis sheath for a certain distance, and then puncture the posterior sheath and parietal peritoneum into the abdominal cavity at a predetermined position. The role of fixed prevention of bleaching tube, while reducing the number of operating holes, is conducive to reducing the possibility of postoperative peritoneal dialysis leakage ^[1] .

Laparoscopic peritoneal dialysis catheter placement due to accurate placement and suture of the distal end of the catheter can effectively reduce the drift rate, occlusion rate and prolong the useful life of the peritoneal dialysis catheter. It should be used as the first choice Methods, especially for patients with a previous history of abdominal surgery.

There are advantages and disadvantages to each catheterization method, and current evidence-based medical evidence does not support which method is best. How to choose the catheterization method for individual patients needs to be individualized according to the clinical situation and the operator's catheterization experience. However, minimally invasive, visual, and easy-to-operate peritoneal dialysis catheterization will definitely become the new trend of development of peritoneal dialysis catheterization.

Location selection of peritoneal dialysis tube

The choice of placement of peritoneal dialysis catheter on the body surface is a very important step in establishing a smooth peritoneal dialysis access. To keep the peritoneal dialysis drainage smooth and reduce the complications of catheterization, we must be familiar with the anatomy of the anterior wall of the abdomen and choose the most appropriate peritoneal catheter insertion point. Usually, the skin incision is placed at the midline or 3cm below the umbilicus near the midline. The former surgery is simple and easy to master, but the latter may reduce skin outlet leakage and abdominal wall hernia, so it is more commonly used. In addition, the incision of the tall patient can be selected from the left lateral center, and the short patient can be selected from the right lateral center. For patients who are sexually active, the corresponding position of the left lower abdomen on the opposite side of the Mai's point can be selected. At present, the following parts are usually used for the localization of the Tenkkhoff abdominal catheter:

1) A 2 ~ 3cm inferior umbilical incision via the left lateral median (transverse rectus abdominis) is a more commonly used positioning method in China. It avoids the direction of large vessels in the abdominal wall. The incidence of dialysis fluid drainage obstacles after implantation is about 10%.

2) There are no large blood vessels and muscle tissues at the mid-centre puncture point 2cm below the umbilicus, so there is less chance of bleeding during the puncture.

3) The inverse Maiss point incision is made in the middle and outer 1/3 of the left anterior superior iliac spine and the umbilical line. The omentum is less and sparse in this area, and there is less chance of being wrapped by the omentum.

4) The midpoint between the anterior superior iliac spine and the midline. This point passes through the lateral margin of the left rectus abdominis sheath. There are no large abdominal wall blood vessels and too much muscle tissue. It can be used as a puncture catheterization point.

5) There are more than 700 cases of clinically implanted tube with the upper surface of the pubic symphysis 8-9cm through the left midpoint, and the incidence of poor drainage of peritoneal fluid is less than 3%.

Complications of peritoneal dialysis tube

There are three main complications of peritoneal dialysis intubation:

1) Leak around the peritoneal tube

It usually occurs after catheter implantation and the symptoms are a wet dressing at the exit. Contrast is injected into the abdominal cavity and a CT scan is performed to confirm the diagnosis. Peritoneal dialysis fluid should be drained during treatment, the abdominal cavity should be emptied, and the dialysis should be stopped for at least 24-48 hours. The longer the venting time, the greater the chance of leak healing, and the ineffective person should remove the catheter and reimplant it in other parts. It must be noted that ligation at the exit site of the leak does not help the treatment, instead it allows the leaked fluid to enter the surrounding subcutaneous tissue.

2) The dialysate does not flow smoothly

When the amount of dialysate released is significantly lower than the input volume and there is no peritubular leakage, poor drainage should be considered. Common causes include twisted peritoneal peritoneal tube, and the inflow and outflow of peritoneal peritoneal fluid are blocked. In this case, the peritoneal peritoneal tube needs to be repositioned. Intestinal peristalsis is weakened, and patients with constipation are also common causes of peritoneal peritoneal fluid outflow. Laxatives or saline enemas are required. After the recovery of intestinal motility is promoted, 50% of the outflows can be resolved. The fibrin clot is blocked. Observe the presence of fibrin clot in the peritoneal dialysis fluid. Heparin 200-500U / L is added to the solution to prevent fibrous obstruction of the pipeline. If heparin is not effective, try thrombolytic agents such as urokinase or streptokinase; the omentum or other organs wrap the dialysis tube. Reset the peritoneal tube off-line, under laparoscopy or surgery; if combined, actively treat peritonitis.

3) Skin exit or tunnel infection

About a quarter of peritonitis episodes are associated with exit or tunnel infections. Mainly caused by Staphylococcus aureus and Gram-negative bacteria, treatment requires local debridement, dressing change and anti-inflammatory treatment. If the infection at the outlet does not improve after 4 weeks of treatment, extubation is usually performed.

Peritoneal dialysis tube

The peritoneal dialysis tube is a necessary way to maintain peritoneal dialysis and exchange of peritoneal dialysis fluid. The dialysis tube should be removed when:

1. Uncontrollable purulent inflammation in a subcutaneous tunnel.

2. Severe infection at the exit of the refractory dialysis tube.

3. Uncontrollable multiple peritonitis, especially fungal peritonitis.

4. Fecal peritonitis.

5. Continuous leakage of dialysate.

6. Patients with poor drainage of the dialysate, and still unable to restore normal drainage after being treated by other methods.

7. Dialysis tube is completely blocked.

8. Reversible uremia, recovery of renal function and discontinuation of peritoneal dialysis.

9. Diverted to hemodialysis or kidney transplant.

Wound care for patients with surgical site infection after peritoneal dialysis tube removal

1. After diagnosis of infection at the surgical site, debride as soon as possible to avoid further expansion of the pus cavity.

2. The method of wound debridement is mainly autolytic debridement, supplemented by a combination of sharp debridement and mechanical debridement, and a small number of times to remove non-living tissue from the wound to maximize the preservation of healthy tissue.

3. At the same time, actively prepare the wound bed at different stages of wound healing, choose the correct dressing, pay attention to the patient's psychological care, and provide a strong guarantee for the smooth healing of the wound ^[2] .

Peritoneal dialysis tube

Peritoneal dialysis is the use of the peritoneum as a semi-permeable membrane, and the prepared dialysate is infused into the patient's peritoneal cavity through the catheter using gravity. In this way, there is a difference in the concentration gradient of the solute on both sides of the peritoneum. The solute moves to the low concentration side (dispersion); the water moves from the low permeability side to the high permeability side (osmosis). The peritoneal dialysis fluid is continuously replaced to achieve the purpose of removing metabolites and toxic substances in the body and correcting water and electrolyte balance disorders. Peritoneal dialysis is one of the main alternative therapies for acute and chronic renal failure. Compared with hemodialysis, it has the characteristics of simple operation, self-dialysis, and maximum protection of residual renal function.