Under a general anesthesia with muscle paralysis and assisted ventilation, the patient is put on the supine position with the head tilted down. A 2-mm supraumbilical incision is made and the pneumoperitoneum is performed by inserting a Veress needle, creating a 2-mm portal. After establishing pneumoperitoneum (CO2) with Trendelenburg positioning, an 18-gauge needle is introduced into the right and left lower quadrants. A guidewire is inserted through the 18-gauge needle and advanced to the true pelvic cavity. The dilator and sheath are advanced over the guidewire. Then, a continuous ambulatory peritoneal dialysis catheter is advanced through the sheath, over the right lower quadrant toward the pelvis. The sheath and guidewire are removed. A 5 cm subcutaneous tunnel is made by blunt dissection through the exit wound above the belt line. The catheter position is verified by direct visualization. A second 2-mm trocar may be placed to guide the catheter toward the pelvis. The catheter is flushed with heparinized saline. Local anesthesia is administered and the skin incisions are closed. Placement of the catheter can be performed under local anesthesia. This method has been described utilizing helium or nitrous gas, which is less irritating to the peritoneum than carbon dioxide.

0 0

Post a comment