Pericatheter and Subcutaneous Leaks

Pericatheter and subcutaneous leaks are often related to poor catheter implantation technique, anatomical abnormalities, early use of the recently placed catheter or trauma.¹ Leakage occurring in the first 30 days following catheter implantation is usually external in nature and is evident at the catheter exit-site or surgical incision. Subcutaneous leaks may resolve with a prolonged rest period or dry day. Subcutaneous leakage involving the genital region or abdominal wall usually indicates a larger leak requiring exploration of the incision site or evaluation for an anatomical defect. Attention to surgical recommendations on insertion location (paramedian approach) and positioning of internal cuff reduce the risk of leakage.¹

Leaks confined to the genital area can occur thru a patent processus vaginalis, an embryological structure that allows for the developing genitals to exit the abdominal cavity into their mature anatomic location. In many individuals this processus vaginalis structure does not fuse normally after the genitals exit and allows for a patent communication between the abdominal cavity and genital anatomy.² These patients may present with massive scrotal or labial edema during initiation of PD.

Leaks are detected clinically by visualizing clear dialysate at the exit-site, by examination of the subcutaneous tissue that would present with a feeling of induration and fullness, or by obvious genital edema. Leaks at the exit-site can be confirmed with glucose testing of the visible fluid. Subcutaneous leaks and genital leaks can be confirmed by either CT peritoneography, scintigraphy, or MRI.^{3, 4, 5}