Percutaneous Catheter Insertion FAQs

In one word, “availability.” 

• Nearly every country in the world has experienced the negative impact of COVID-19, especially on availability of hospital operating rooms and beds. 
• The planet is also experiencing dramatic increases of geological, hydrological and meteorological disasters, which also impact health care resource availability. 
• However, such events have negligible effect on the availability of percutaneous PD catheter placements performed by nephrologists.

    Under pandemic and disaster circumstances, many medical operations and procedures — including placement of open laparotomy and laparoscopic PD catheters — may be judged as elective. Because being able to start PD is an essential contributor to your patients’ health, and because events such as these will continue to cease, limit or delay your ability to schedule and assure placement of open laparotomy and laparoscopic PD catheters, you can now become your patients’ direct line to PD. 

Consider doing percutaneous PD catheter placement because:

• You likely chose nephrology so you could apply knowledge, skills and aptitudes to solve challenging problems. 
• Your top priority is treating your patients, and you can make a significant difference by being the direct line between patients who requested PD and those who actually start on it.
• Your clinic has a maximum number of HD chairs and HD systems, and the incidence of CKD in the population continues to rise.
• The procedure requires significantly fewer health care resources.
• The procedure allows more patients to begin PD and enjoy the quality of life PD affords.
• Learning the procedural skills and performing the procedure will help you treat many more patients using the modality they wanted and potentially increase the number of patients you serve.

Instead of waiting to get onto a surgeon’s schedule and having to schedule an OR, your patient receives their PD catheter as an out-patient, under local and mild anesthesia. Your patient will also heal faster and start needed PD therapy much sooner.

When you refer to surgeons, you may experience delay in initiating PD therapy because of the waiting time to see the surgeon and the time required to arrange the procedure afterwards. By performing the insertion procedure, yourself:

• You don’t have to schedule a surgeon or an OR or tie up recovery room and associated hospital staff. 
• You rely on your own internal scheduling system, you have direct scheduling contact with patients, and you provide ways to relax and prep the patient for the catheter insertion. 
• You administer local anesthesia without need for clearance. 
• And, you may experience a reduction in complication rates. In some centers using the Seldinger technique, the catheter survival rates were even better than for those implanted by open surgical method in patients who had no prior abdominal surgeries.^1,2 

Some studies suggest that dialysis can be safely started 24 hours after placement.³  Other studies suggest dialysis — if performed using low-volume exchanges and short dwell times with the patient in a supine position — can begin immediately after percutaneous PD catheter insertion.⁴

Normally, dialysis after laparoscopic placement and open placement must be delayed until 14 days after catheter placement.⁵

True, a CVC can be used immediately, but it is obviously not suitable for long-term vascular access. Risk of infection is high, and it is known for frequent problems that reduce adequacy of HD therapy.⁶ Learning how to place a PD catheter percutaneously avoids the downside of having a CVC and offers PD to your patients who chose it. 

You already know the necessary skills from medical school: maintaining a sterile field, injecting local anesthetics, making small incisions, blunt dissecting, and suturing. With Baxter training and practice, you can polish and refine those skills and confidently perform the catheter placement. 

Setting up a percutaneous PD catheter placement program does not require major changes in the clinic infrastructure. There is no fixed requirement for additional staffing. An equipped procedure room, sterile supplies and catheter kits, and training — which you may request from Baxter — are generally all that’s needed.

Yes, most are. There are some exceptions, which are discussed in a number of our E-Learning materials, but the majority are indeed suitable, eligible and will experience reliable long-term success.