Preoperative Mapping to Determine the Most Appropriate Catheter Type, Insertion Site, and Exit-Site Location

Since patients come in all sizes and shapes with a variety of medical conditions, one catheter type cannot be expected to fit all. Choice of catheter type should take into consideration the patient’s belt line, obesity, skin creases and folds, presence of scars, chronic skin conditions, incontinence, physical limitations, bathing habits, and occupation. It is imperative that the peritoneal dialysis access team, including the surgeon, interventional radiologist, nephrologist, and PD nurse, be familiar with a basic inventory of catheter types to enable customization of the peritoneal access to the specific needs of the patient and to afford maximum flexibility in exit-site location. A poor exit-site location that the patient cannot easily see or take care of predisposes to exit-site and tunnel infection.^1-4

Often, hospital vendor contracts and purchasing agents determine the kind of peritoneal catheter maintained in stock. Moreover, the type of catheter provided is subject to change without notice. Considering current progress in peritoneal access technology, leaving catheter choice up to nonmedical personnel is unacceptable. The PD team must agree on a basic catheter inventory and insist that these specific items are made available for the peritoneal access procedure. It is impossible for a PD program to develop a dependable protocol for catheter selection if the catheter types and dimensions are constantly changing. In addition, it is essential that each member of the PD access team understands and acknowledges that the preoperative mapping procedure described herein is a definitive and reproducible method that can be performed by any of the team members for selecting the most suitable catheter type, insertion site, and exit-site location.