multiple side holes of about 500 microns in diameter. Coiled catheters
tend to migrate less and cause less pain with dialysate infusion.
Catheters such as the Toronto Western have two silicone discs (placed in
the intraperitoneal portion) which limit the free movement of the tip
keeping the intraperitoneal portion in the pelvis thus reducing migration, a
common problem with straight and coiled PD catheters.
The extraperitoneal segment of the PD catheter may be straight or bent
(swan-neck). Because of their configuration, bent catheters are associated
with fewer occurrences of cuff extrusion and leaks. [41, 42]
- Catheter placement
PD catheters are usually inserted surgically and occasionally
percutaneously with radiologic guidance. Peritoneoscopic and
laparoscopic techniques of catheter insertion are well described and are
associated with decreased rates of site infections, leaks and prolonged
catheter survival. [45]
The tip of the catheter or coiled part of the intraperitoneal segment should
be placed in the pouch of Douglas between the visceral and parietal
peritoneum.
The internal cuff is placed in the musculature of the abdomen and the
external cuff in the subcutaneous tissue. The catheter should exit facing
downward and laterally and the exit site should not be placed near the
midline, belt line or near any prior scars.
For children with ostomies, fecal incontinence or obesity, the presternal
exit site is preferred.
