Abstract

Background: Peritoneal dialysis (PD) is a home-based treatment for kidney failure that uses the lining of the abdomen (peritoneum) to filter waste and excess fluids from the blood without machines or needles.

Method: A retrospective study was conducted using data obtained from clinical records of patients who underwent peritoneal dialysis catheter placement using a percutaneous technique.

Results: Of the 86 patients, the minimum age was 22 years and the maximum age was 82 years, with a mean age of 64 years. There were 41 men and 45 women.

Conclusion: The data presented in this study clearly demonstrate the multiple advantages of using the percutaneous technique for peritoneal dialysis catheter placement.

Keywords

Peritoneal Dialysis; Percutaneous Technique; Peritoneal Catheter; Peritoneal Access; Chronic Kidney Disease; Kidney Failure; Catheter Placement; Renal Replacement Therapy

Introduction

Peritoneal Dialysis (PD) has been widely shown to be an optimal and well-tolerated therapy for eligible patients. Currently, in a general hospital like ours, surgical waiting times are longer than desired. It has been demonstrated that the time to initiate renal replacement therapy is directly related to increased morbidity and mortality [1]. Successful peritoneal dialysis requires secure, functional, and well-maintained access positioned in the abdominal cavity to allow bidirectional flow of the dialyzing solution [2].

The percutaneous technique is a viable, safe, and functional option; it even allows for the inclusion of patients with anesthetic contraindications in cases where the patient’s clinical condition necessitates its use. For early or unscheduled renal replacement therapy, the use of small infusion volumes (500-1000 cc) is recommended, with the patient in the supine position and on a dry day [3]. This allows for timely initiation of renal replacement therapy, thereby improving morbidity and mortality. Additionally, the procedure offers an optimal cost-benefit ratio.

Methods

A retrospective study was conducted using data obtained from clinical records of patients who underwent peritoneal dialysis catheter placement using a percutaneous technique.

Patients: A total of 86 cases of stage 5 chronic kidney disease were included in the study. 78 of these patients were newly started on peritoneal dialysis, and 8 were switched to peritoneal dialysis. The study took place over a 6-year period, ending October 1, 2023, at the Morelia Regional Hospital, ISSSTE. COVIDIEN brand catheters, model “Argyle 57cm”, with two cuffs, were used. Placement was performed in 100% of cases by a nephrologist and a general surgeon at the patient’s bedside.

Method for placement of peritoneal dialysis catheter

Dissection of the puncture site

It consists of asepsis and antisepsis of the abdominal region, placement of sterile drapes, selection of the incision or puncture area, infiltration of the anesthetic and incision of 0.5-1.0 cm in length. Dissection of anatomical planes and perforation of the peritoneum with Kelly forceps.

Catheter placement

The catheter is mounted on the guidewire, verifying its position and positioning. At a 90° angle, it is passed through the puncture site until it reaches the peritoneal cavity, where the guidewire is withdrawn half a centimeter to prevent accidents. It is directed at a 45° angle toward the pelvic cavity, as Computed Peritoneography (CT) has shown that between 30% and 55% of the dialysate rests in the pelvis when the patient is supine, supporting the concept of preferentially placing the distal end of the catheter in the lesser pelvis for optimal function [4]; until the first cuff reaches the muscular aponeurosis, where it will remain. The guidewire is then removed, and the tunnel is created. Sutures are not recommended to fix the cuff [5].

Tunnel construction

The exit site is selected at a 90° angle from the patient’s midline. The distal end of the catheter is inserted into the tunneling device, which creates the tunnel and exit site to the same diameter as the catheter. It is inserted into the adipose tissue or immediately beneath it, taking care not to stretch, rotate, or bend it. The second cuff should be placed 2 cm before the exit site and should never be oriented vertically.

Start of dialysis

The titanium connector and transfer line are placed. The inflow and outflow times of the dialysate are checked; if they are longer than recommended, it is suggested to redirect the catheter with the guidewire or reposition it. The subcutaneous tissue and skin are sutured, covered with a sterile dressing, and PD is started according to the nephrologist’s recommendations [6].

Results

The functionality of the peritoneal access is evaluated at 30 days and one year, as well as the main complications which, according to the literature, are: site infection, peritonitis associated with peritoneal dialysis, survival in the first year, leakage of dialysis fluid, bleeding, perforation of hollow viscus, slow effluent.

Of the 86 patients, the minimum age was 22 years and the maximum age was 82 years, with a mean age of 64 years. There were 41 men and 45 women. In all cases, the catheter was placed on the same day of admission and used immediately; this demonstrates the multiple advantages: it eliminates anesthetic risk, the waiting time for the start of renal replacement therapy (which increases the risk of morbidity and mortality), and, from a pharmacoeconomic perspective, it results in low healthcare costs. This marks a turning point in our institution, allowing us to implement this procedure in all cases where there are no contraindications.

Discussion

It is important to note that, during the study period, our hospital did not have ultrasound equipment available to guide the procedure. Consequently, all 86 peritoneal dialysis catheter insertions were performed using a blind percutaneous technique (with a metal guidewire).

This institutional limitation means that our series reflects exclusively the results and complications associated with the percutaneous technique guided solely by anatomical landmarks. No visceral injuries (such as intestinal perforation or liver injury) were recorded in any of the cases, likely due to the careful selection of the puncture site, the layered dissection, and the use of the metal guidewire with depth control, as described in the methodology. Had visceral injuries occurred, the institutional protocol would have included surgical or conservative management depending on the severity, but no cases requiring such intervention were observed [7].

The literature shows that ultrasound-guided techniques yield favorable results; however, the results obtained with the traditional technique are not inferior to those of ultrasound-guided procedures. It is important to note that ultrasound is operator-dependent, and lacking a proficiency curve, we opted for the technique we are most proficient in. We should also mention that all patients underwent prior ultrasound examinations for teaching purposes [8].

Conclusion

The data presented in this study clearly demonstrate the multiple advantages of using the percutaneous technique for peritoneal dialysis catheter placement. This technique allows for the early initiation of peritoneal dialysis, reduces waiting time, and thus eliminates the need for hasty decisions, the most common of which is switching to hemodialysis as the only way to initiate renal replacement therapy when the surgical team is entirely dependent on obtaining peritoneal access. Furthermore, it reduces hospital stays and, consequently, morbidity and mortality.

Conflict of Interest

The authors declare no conflict of interest.

Author Contributions

Dr. Gilberto Ceja Cano is a resident surgeon at the Morelia Regional Hospital. Dr. Ximena Flores Bravo is a surgeon at the same hospital, and Dr. Alejandra Galván Ruiz is a nephrologist at the same hospital. None of the authors participated in other studies, nor are they affiliated with any company that funded this article.

References

1. Montenegro Martínez J, Lanuza Luengo M, Morey Molina A (2009) Peritoneal access. In J. Montenegro, R. Correa-Rotter, M. C. Riella (Eds.), Treatise on peritoneal dialysis 109-148. Elsevier España.
2. Yong Kyu Lee, Pil-Sung Yang, Kyoung Sook Park, Kyu Hun Choi, Beom Seok Kim (2015) Peritoneal dialysis access. Yonsei Med J 56: 981- 986. [Ref.]
3. Passadakis PS, Oreopoulos DG (2007) Peritoneal dialysis in patients with acute renal failure. Adv Perit Dial 23: 7-16. [Ref.]
4. Crabtree JH, Shrestha BM, Chow KM, Figueiredo AE, Povlsen JV, et al. (2019) Creating and Maintaining Optimal Peritoneal Dialysis Access in the Adult Patient: 2019 Update. Perit Dial Int 39: 414-436. [Ref.]
5. Méndez-Durán A (2010) Percutaneous technique for peritoneal dialysis catheter placement. Dialysis and Transplantation 31: 72-75.
6. Cholerzyńska H, Zasada W, Michalak H, Miedziaszczyk M, Oko A, et al. (2023) Urgent Implantation of Peritoneal Dialysis Catheter in Chronic Kidney Disease and Acute Kidney Injury-A Review. J Clin Med 12: 5079. [Ref.]
7. Lee YK, Yang PS, Park KS, Choi KH, Kim BS (2015) Modified Peritoneal Dialysis Catheter Insertion: Comparison with a Conventional Method. Yonsei Med J 56: 981-986. [Ref.]
8. Chan CE, Sze XQ, Low JM, P’ng HS (2026) Ultrasound-Guided Percutaneous Peritoneal Dialysis Catheter Insertion With Musculofascial Tunnelling Reduces Catheter Migration- Observational Retrospective Cohort Study. Nephrology (Carlton) 31: e70180. [Ref.]

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Article Information

Article Type: RESEARCH ARTICLE

Citation: Cano GC, Bravo XF, Ruiz AG, Gonzalez Galindez LO (2026) Systematic Implementation of the Percutaneous Technique for the Institution of Peritoneal Dialysis. Cohort Evaluation and Literature Review. Int J Nephrol Kidney Fail 12(2): dx.doi.org/10.16966/2380-5498.268

Copyright: © 2026 Cano GC, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication history: 

Received date: 15 Apr, 2026

Accepted date: 24 Apr, 2026

Published date: 06 May, 2026