Peritoneal Dialysis Access
A minor operation that gets you ready for dialysis involving the lining of your abdomen
What To Expect Before, During and After Your Procedure
You and your doctor have weighed the pros and cons of peritoneal dialysis versus hemodialysis and have decided that peritoneal dialysis is the best treatment for you. Now, it's time to create a way to access your blood. At Beth Israel Deaconess Medical Center (BIDMC), we help you prepare and know what to expect.
What is Peritoneal Dialysis?
Peritoneal dialysis is one of the two ways to filter your blood if you have kidney failure and your kidneys can’t do the work themselves.
The treatment involves flushing your abdominal cavity with a diluted dextrose (sugar) solution. The lining inside your abdomen acts as a filter to purify your blood. Waste is trapped in the solution, which you drain from your abdomen through a Tenckhoff catheter — a special tube that we place during dialysis access surgery.
You can do peritoneal dialysis during the day at home or at work with four fluid exchanges through your catheter. You can also do the treatment overnight using a special machine that flushes your system while you sleep. It’s your choice. Because scar tissue may interfere with the effectiveness of the treatment, peritoneal dialysis may not be the best treatment for you if you’ve had abdominal surgery in the past.
More About Peritoneal Dialysis Access
Beginning peritoneal dialysis takes time. You meet with the dialysis access nurse coordinator who will schedule your surgery. You’re also likely to undergo certain tests before your procedure. During this time, we watch your kidney function closely so you can receive surgery at the right time.
We refer to your surgery as peritoneal dialysis access surgery because it establishes access for your dialysis treatment. The surgery takes place in an operating room. During the procedure, you receive a local anesthetic to numb the access site and IV sedation to keep you comfortable. Some people fall asleep. Others report minimal discomfort.
Your surgeon makes a small incision in your abdomen and advances the Tenckhoff catheter deep into the lower part of your peritoneal cavity (the membrane that lines the inside of your abdomen). Surgeons tunnel the catheter under your skin for several inches before bringing it up through your skin in a different location. Then, they close the initial incision and cover the portion of the catheter that’s outside your body with a sterile dressing. The operation takes one to two hours.
Tunneling the catheter reduces the likelihood of infection in your peritoneal cavity. In most cases, you go home the same day as your surgery. But after your operation, you stay with us for one to three hours to recover. Your dialysis treatments won’t begin until your incisions heal. Usually, that happens about two to four weeks after surgery.
Complications related to placing the catheter are rare but can include bleeding and damage to your large or small intestines or abdominal blood vessels. If these problems occur, you may need additional surgery to correct them.
Caring for yourself after dialysis access surgery is very important. We provide complete instructions.
After access surgery, you will likely have some pain around your access site. You may also notice a small amount of drainage on your dressing. That’s normal. Try not to strain the access site or disturb your dressing. The area around your catheter needs time to heal.
In the weeks after your access surgery, a peritoneal dialysis (PD) nurse will work with you to help you learn how to manage your treatments on your own. They’re always available to help you with any questions or concerns.
Surgical Dressing Care
You shouldn’t change or remove your surgical dressing. You may put clean gauze over the area, but the dressing that’s there should stay there. If your dressing is soaked with blood or you see thick, yellow discharge (pus) on the dressing, it’s important to call your dialysis access nurse coordinator or your PD nurse.
Don’t shower, take a tub bath or allow the dressing to become wet until you speak with your PD nurse at your next appointment. That takes place about one week after access surgery.
If your dressing becomes wet, blood-soaked or falls off, call your dialysis access nurse coordinator.
In most cases, there are no stitches that need to be removed.
Activity After Peritoneal Dialysis Access Surgery
After surgery, keep these safety tips in mind:
- Avoid lifting anything that weighs more than 5 pounds for two weeks. This is important to avoid straining the area of surgery.
- For at least two weeks, avoid any activity that causes you to tighten your abdominal muscles (for example, heavy housework, having sex or heavy exercise routines). Easy walking is okay. Talk with your PD nurse about when you may resume more strenuous activities.
- For at least two weeks, do not strain when you are having a bowel movement. If you need a stool softener or laxative, please contact your doctor for advice.
- It's okay to drive when you feel ready, after you have stopped taking prescription pain medicine.
- Talk with your surgeon or PD nurse about when you may return to work. This will depend on the kind of work you do.
Treatment Complications
Once your dialysis begins, peritonitis is a possible complication. Peritonitis is an infection of your peritoneal cavity. It’s related to the repeated use of your catheter and can be quite serious. Symptoms may include:
- Abdominal pain.
- Cloudy peritoneal dialysis solution.
- Fever.
If you develop these symptoms, notify your PD nurse. We usually treat peritonitis with antibiotics. But if the infection doesn’t respond to treatment, we may have to remove your catheter.
