Peritoneal Dialysis Catheter Removal

Peritoneal dialysis catheter removal can also be safely performed without significant discomfort under local anesthesia. Here too, an operating room is not needed because the procedure can be performed in a procedure room using standard precautions for infection control. Briefly, the local anesthetic is infiltrated at the site of the primary incision and the subcutaneous tissue. Dissection is then carried down to the subcutaneous tissue and the subcutaneous tunnel harboring the catheter is identified. Using blunt dissection, a portion of the tunnel is separated from the surrounding tissue. The tunnel is then lifted by applying a hemostat under it. Using toothed forceps and Metzenbaum scissors, the tunnel layers are cut in a longitudinal direction and the catheter is exposed (Fig. 7). The catheter is clamped with hemostats and a nylon suture is applied through the catheter just outside the hemostats as a tag. At this point, the catheter is cut just outside the hemostat (remaining inside the nylon tag suture). Using Metzenbaum scissors, dissection is performed exposing tissue in the direction of the deep cuff. At this point, local anesthetic is infiltrated around the deep cuff. For catheters that have been in place for less than a month, blunt dissection using hemostats is all that is required to free the superficial and the deep cuff. For catheters in place for more than a month, sharp dissection using Metzenbaum scissors and a scalpel is needed. Exposure of the deep cuff and the anterior rectus sheath is required. Once the deep cuff is separated from the surrounding tissue, the intraperitoneal portion of the catheter is gently withdrawn from the peritoneal cavity. The defect created at the entry point (anterior rectus sheath) of the catheter is then closed with a purse-string suture using an absorbable material. The nylon tag is then pulled to expose the cut surface of the outer catheter segment and dissection is performed in the direction of the superficial cuff. Once the superficial cuff is free, this portion of the catheter can be easily removed through the primary incision site or the exit site. Absorbable suture material such as Vicryl is used to close the subcutaneous tissue while nylon is used to close the skin. The exit site is not sutured. The procedure should be performed only with sterile technique, good lighting, and antiseptic skin preparation.

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