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Routine Percutaneous Insertion of Permanent Peritoneal Dialysis Catheters on the Nephrology Ward

Although percutaneous placement of chronic peritoneal dialysis catheters using a Seldinger guide wire technique was described as long ago as 1984 (1,2), most renal units in the United Kingdom still use a minilaparotomy with general anesthesia for routine catheter insertion and reserve the percutaneous technique for patients who are unfit for surgery (3). Surgical catheter placement requires operating room facilities and staff, a surgeon, and often the use of general anesthesia. The wound is up to 10 cm in length, and a period of postoperative hospitalization is normally required. On the contrary, the percutaneous technique can be performed by a physician at the bedside under local anesthesia, the scar is only 2 cm long, and the procedure is associated with minimal postoperative discomfort. A chronic dialysis program was established in our unit in early 1990. We decided from the outset routinely to place all permanent dialysis catheters under local anesthesia using a percutaneous technique on an open nephrology ward. The only exceptions were patients with a high risk of lower abdominal adhesions who were referred for surgical placement under general anesthesia. Where possible, the procedure was performed on an outpatient basis a week or so prior to commencement of treatment. We describe our experience with the first 46 catheter insertions using this protocol, 31 of the catheters having been inserted percutaneous ly.