About your peritoneal dialysis catheter Information for patients Sheffield Kidney Institute (Renal Unit)
Introduction You will have discussed with your doctor that your kidney condition means that you soon need to start peritoneal dialysis. In this leaflet we explain what a peritoneal dialysis (PD) catheter is, what it does and how you need to look after it. We hope that we will have answered all your questions. If after reading this leaflet you would like to know more or have some questions, please speak to a member of staff at the renal unit. What is a peritoneal dialysis catheter? A PD catheter is a soft, flexible tube that is made of silicone. Silicone is a man-made material sometimes used instead of rubber. The PD catheter is hollow and is about the width of a pencil. The PD catheter carries dialysis fluid into and out of the abdomen (tummy) and allows peritoneal dialysis to be carried out. Without a PD catheter you will not be able to have peritoneal dialysis. A nurse from the PD team will talk with you about the PD catheter and the best and most comfortable place for it to be put in. What is peritoneal dialysis? Peritoneal dialysis is a treatment for kidney failure that removes waste from the blood. This waste builds up in the blood because of kidney failure. The blood is cleaned inside the body using the peritoneal membrane, a natural lining inside the abdomen and a glucose (sugar) fluid. The fluid is drained into the tummy using the PD catheter. The wastes then pass from the blood through the peritoneal membrane (lining) that acts like a filter, and into the dialysis fluid. page 2 of 8
After a few hours, the fluid and waste can be drained from the body through the PD catheter. Fresh, clean fluid is then drained into the abdomen and the cleaning of the waste starts again. Liver Stomach Bowel Peritoneal dialysis catheter Bladder Peritoneal membrane Bowel Peritoneal dialysis fluid Womb Rectum Diagram showing the position of the PD catheter in the body How is the catheter put in? In order to have the PD catheter put in you will need an operation. A surgeon will place your PD catheter into your abdomen. The operation is usually done using an anaesthetic put into the spine but in some cases page 3 of 8
it may be done under a local or a general anaesthetic. The operation usually takes about half an hour. We must obtain your consent for any procedure or treatment beforehand. Staff will explain all the risks, benefits and alternatives before they ask for your consent. If you are unsure about any aspect of the procedure or treatment proposed, please do not hesitate to ask for more information. One end of the PD catheter is put in through a small cut below your tummy button (navel). The other end of the PD catheter is threaded (tunnelled) under the skin and comes out to the left or right side of your abdomen. Where the PD catheter comes out of your abdomen is called the exit site. Do I need a check up before the operation? Before your operation you will get an appointment to come to the pre-assessment clinic at the hospital. At the clinic you will have all the tests you need to make sure you are well enough to have the operation. It is very important that you come for this check up. The operation may need to be arranged for another time if you need more tests or are not fit enough to have the operation. A nurse from the PD team will give you laxatives, a body wash and an antibiotic nose cream to use before your operation. Your bowel needs to be emptied of stool (poo) before the surgery. For the PD to work it is important that your bowels work regularly and that the stool you pass is soft. The laxatives allow this to happen. You need to use the body wash to thoroughly clean your skin before the operation. Please bring the body wash with you when you come to the hospital. page 4 of 8
The antibiotic nose cream removes germs (bacteria) that can live in your nose. While these germs do not usually cause you harm, they may drop onto the area where your PD catheter enters your tummy and cause an infection so we remove them before the PD catheter is put in by the surgeon. The nurse will tell you when and how to take the laxatives, body wash and nose cream. What will happen on the day of the operation? On the morning of your operation your abdomen will be examined by the surgeon. This is to finally decide where the PD catheter will be put in. This place will be marked with a waterproof marker pen ready for your operation. You will also be given an antibiotic injection into a vein before you go to theatre. This is to help prevent you getting an infection in the wound or the PD catheter exit site. How long will I need to stay in hospital? Usually you will be admitted to the hospital on the day of your operation. You should be able to go home a few hours after the operation unless you are not able to look after yourself. If you go home on the day of the operation, you must have another adult with you for 24 hours after the operation. Very rarely things can go wrong when you have the catheter put in. If this happens to you, you will need to stay in hospital for longer. We explain more about these problems later in the leaflet. If you are having the PD catheter put in while you are an inpatient, you will need to stay in hospital until all of your care and treatment is finished. page 5 of 8
What happens after the operation? After the operation you will go back to the ward. The nurses on the ward will: Check your blood pressure, pulse and breathing regularly Check your temperature Check your wound and the PD catheter exit site regularly Make sure you are comfortable. If you have any discomfort or pain you will be offered pain relief. Any pain does usually go away within a few days. The nurses may also flush your PD catheter and abdomen with the sugar dialysis fluid to check the PD catheter is working Can anything go wrong when I have my PD catheter put in? As with any operation there is a risk of you getting an infection, bleeding and bruising. Sometimes the wound dressing can become stained with a small amount of blood. Some people can bleed more than this from the wound or the exit site. If this happens you will be seen by the surgeon and may need more treatment for this. Sometimes the PD catheter will not flush properly. If this happens you will be seen by the surgeon and may need more treatment. Sometimes the PD catheter can move from the right place in the abdomen. You will need an x-ray to check if this has happened. Occasionally some people need to have another operation to make the PD catheter work properly again. Very occasionally there is injury to the bowel or bladder. The surgeon will talk to you about this in more detail before your operation and you can ask any questions you may have. page 6 of 8
What happens when I go home? Before you go home a nurse from the PD team will visit you on the ward. They will tell you how to look after yourself and the PD catheter at home. They will also arrange to see you again in clinic about 5 days after you go home. (Please see the end of this leaflet for a reminder of the date of this appointment). You will also be able to ask the nurse any questions you may have. How to look after your PD catheter and exit site By following these instructions you will reduce the risk of getting an infection and help the wound to heal. It will also help to make sure the PD catheter works properly when you start learning how to do your PD. Keep the wound and exit site covered with the dressing at all times. You must not have a bath or shower or go swimming until a nurse from the PD team tells you it is safe to do so. Make sure the dressing is clean and dry at all times. If the dressing gets dirty or loose or has fallen off you must call the Renal Unit. We tell you how to do this at the end of the leaflet. Keep the PD catheter well taped to your abdomen. You should not drive until you are free of pain from the operation. Do not lift, push or pull heavy objects. Be careful what jobs you do around the house. You must take the laxatives you have been given to allow you to pass soft stools regularly. Please contact the PD Team for advice if you have not had your bowels opened 48 hours following your operation. page 7 of 8
The stitches you have are usually the type that will dissolve by themselves. If you have a different type of stitch that needs to be removed, the ward staff will arrange for a nurse from your GP surgery to do this. If you notice any leaking or bleeding from your wound and exit site you must contact the Renal Unit straight away. If you feel that your pain is getting worse, call the Renal Unit for advice. Your clinic appointment is: on (date) at (time) at (place) If you have any questions or need help and advice please call: PD Team: 0114 271 4042 Monday - Friday 8.30am - 4.30pm We have a voicemail for you to leave messages Renal Ward: 0114 271 5886 or 0114 226 6391 After 4.30pm and at weekends. Produced with support from Sheffield Hospitals Charity Working together we can help local patients feel even better To donate visit www.sheffieldhospitalscharity.org.uk Registered Charity No 1169762 Alternative formats can be available on request. Please email: alternativeformats@sth.nhs.uk Sheffield Teaching Hospitals NHS Foundation Trust 2017 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No.1515. Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. Email infogov@sth.nhs.uk PD6016-PIL2265 v5 Issue Date: August 2017. Review Date: August 2019