Kidney Dialysis in Greensboro, NC
Peritoneal Dialysis Catheter
Healthy kidneys remove excess water and waste products from the body in the form of urine. When the kidneys cannot do this, serious problems develop and a person can fall into kidney failure. In most cases, the kidneys can heal and recover to a better place. Sometimes the kidneys remain somewhat damaged and a kidney specialist (nephrologist) needs to help manage the disease with medications and adjustments in diet.
Sometimes the kidney failure has progressed too far. The body’s waste and fluid build up in the blood. Hands and legs swell. You start to feel more weak or nauseated. Your blood pressure may rise, placing you at serious risk for heart attack and stroke. If not treated, you will eventually die. Dialysis is a treatment that replaces the work that your kidneys would do if they were healthy to help keep you alive.
How Does Dialysis Work?
Dialysis can be done using a machine outside of the body (hemodialysis) connected to your blood; or, it can be done with a tube placed to enter your abdomen (peritoneal dialysis). The peritoneum is the inner lining of your abdominal cavity, covering the inner organs & abdominal wall. This inner lining of peritoneum works like a filter. Peritoneal dialysis involves placed several quarts of sterile fluid into the inner abdomen/peritoneal cavity. The waste products and fluids can exchange across the peritoneal membrane. The fluid is later removed. Sometimes the catheter can be attached to a machine that runs at night while you sleep (continuous cycling-assisted dialysis = CCPD). Sometimes the fluid can be infused in your abdomen and then later removed hours later (continuous ambulatory peritoneal dialysis = CAPD).
Am I a Candidate for a Dialysis Catheter?
If your nephrologist feels like you are a good candidate, you will be sent to be evaluated by a surgeon to consider placement of a peritoneal dialysis catheter. Your nephrologist generally will have shown you educational videos. You should discuss with dialysis nurses about what life with a peritoneal dialysis catheter is like. Most patients who have not had many abdominal operations are reasonable candidates for placement of a peritoneal dialysis catheter. It is important to understand the risks and benefits of the procedure prior to undergoing surgery.
What to Expect During the Procedure
If your surgeon feels you are a reasonable candidate, you will have a peritoneal dialysis catheter placed. This requires an operation under general anesthesia. The surgeon places a soft plastic tube (Missouri curl catheter) into your abdomen. The deeper curled tip rests down in the pelvis. The middle part is tunneled inside your abdominal wall where cuffs provide a watertight seal. This leaves an outer foot of plastic tubing resting outside your body, usually in your lower abdomen below the beltline near your waist. This is a quick procedure that can often be done as an outpatient with the possibility of staying overnight.
It takes several weeks for the catheter to heal into a watertight seal. Initially, your nephrologist will have the dialysis nurses do gentle flushes through the catheter. Once the catheter is well sealed in, you will begin larger exchanges of fluid to do full peritoneal dialysis. Your nephrologist and dialysis nurses will help guide you through this.
While placement of the catheter is usually not technically difficult, there are risks to the procedure. The biggest risk is infection. This is why we place the catheter in the operating room with the use of intravenous antibiotics. Using sterile technique to hook up the catheter to your dialysis fluids is essential. Most infections of the catheter are mild and can be treated with antibiotics. However, sometimes the infection worsens or persists and the catheter needs to be removed. Occasionally, the catheters can be blocked due to inner organs plugging up the tubing or kinks. Sometimes the catheter leaks and needs to be replaced. Sometimes the inner abdomen has too many adhesions from prior surgeries or infections and there is not enough space for fluid exchanges to occur. Sometimes, peritoneal dialysis is not enough to compensate for the kidney failure. In rare instances, the inner lining of the abdomen becomes severely thickened or inflamed and peritoneal dialysis can no longer work. Sometimes it is not possible to safely replace a new catheter and the patient must go on hemodialysis permanently. It is very common to need hemodialysis intermittently even if you have a peritoneal dialysis catheter in cases of emergencies or if peritoneal dialysis fails.
Your nephrologist and surgeon can help you decide what the best form of dialysis is for you.