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Kidney Doctor

Peritoneal Dialysis

Peritoneal Dialysis or Homedialysis- Peritoneal dialysis (PD) is a treatment for patients with severe chronic kidney failure. The process uses the patient's peritoneum in the abdomen as a membrane across which fluids and dissolved substances (electrolytes, urea,creatinine, glucose, and other small molecules) are exchanged from the blood. Fluid is introduced through a permanent tube in the abdomen and flushed out either every night while the patient sleeps (automatic peritoneal dialysis) or via regular exchanges throughout the day (continuous ambulatory peritoneal dialysis).
There are two major types of PD:

1. Continuous ambulatory peritoneal dialysis (CAPD)

2. Continuous cycling peritoneal dialysis (CCPD or APD)

CAPD
The procedure include: exchange happens manually with gravity, the dialysis; happens continuously: 24 hours a day and 7 days a week with dwell time lasts 3 to 5 hours; there are about 3-4 exchanges every day.
CCPD or APD
The procedure include: patients attached to a machine names "cycler"; the machine accomplish the exchange automatically based on pre-programmed settings; patients are attached to the machine during the night when sleep; this exchange last 8 to 10 hours. During the daytime, exchange is done manually.
PERCUTANEOUS PERITONEAL DIALYSIS CATHETER PLACEMENT
To receive PD, you will first need to have a small operation. During the operation (which is performed using either a local or a general anesthetic), a plastic tube will be permanently inserted into your abdomen (see diagram). This tube is called a PD catheter. It is about 30 centimeters (12 inches) long and as wide as a pencil. The PD catheter will be placed through your lower abdominal wall, into your peritoneal cavity. Half of the catheter lies inside your abdomen, and half lies outside. It will come out on the right or the left, under your navel (tummy button). The PD catheter acts as a permanent pathway into your peritoneal cavity from the outside world. Without it, you won't be able to perform PD, so it is important you look after it.
Peritoneal dialysis catheters may be placed
1. Percutaneously
2. Laparoscopically
3. Open surgical route
Percutaneous insertion of CAPD catheters under local anesthesia is a well- tolerated, rapidly performed day case procedure, which enables timely initiation of PD. At KCC and PCH, Dr Behura has been regularly inserting CAPD catheter by percutaneous technique. A dedicated intervention suite is present for insertion of CAPD catheter under fluoroscopy guidance.
Advantages of Percutaneous CAPD Catheter Placement:
1. Percutaneous PDC placement compares favourably with the open surgical technique in terms of technical survival and overall complication rates.
2. It is a day care procedure practised under the expertise of experienced nephrologistsand trained CAPD nurses with minimal resources.
3. The percutaneous PDC method offers the advantage of ease of insertion.
4. As this procedure is day care and involves minimal resources; it is a cost effective, safe and reliable procedure as compared to other PDC placement techniques.
5. Percutaneous insertion of CAPD catheters is done under local anesthesia and is well tolerated, rapidly performed procedure which enables timely initiation of PD.
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