Laparoscopic Peritoneal Dialysis Catheter Placement

Anesthesia Implications

Position: Supine, arms at side on armboards
Time: 30-60 min (short)
Blood Loss: Very Low (5-10 ml)
Post-op Pain: Minimal (1-3)
Maintenance Paralytic: Yes

Preop Labs – make sure recent labs are completed. Emphasis will be on potassium. Treat if needed. You’ll want to be at least treating a low potassium when the patient arrives in the OR. Since these are end-stage Renal patients, anticipate creatinine and BUN to be elevated.

Comorbidities – These patients will also have several co-morbidities (DM, HTN, Obesity, CHF, COPD).

IV placement – Only one 20g IV is usually needed. Anticipate a hard stick.

Fluids – Remember to limit fluids (dialysis patient). Most use NS as carrier fluids.

Post-procedure test – Some surgeons like to test the catheter after placement. Be prepared for reverse trendelenburg as fluid is instilled.

Duration – Typically this is a very short procedure, if surgeon is experienced (usually about as long as a laparoscopic cholecystectomy).

Laparoscopic cases (general considerations): The patient’s peritoneum is insufflated (which is called a pneumoperitoneum), and instrumentation will be inserted into the abdomen. General anesthesia, ETT tube, and paralytics are necessary. Some of the procedures are rather short, so make sure the timing is right to reverse the paralytic. The pressure in peritoneum affects the organs of that space. Anything more than 10 mmHg will begin to alter hemodynamics. Cardiac output is decreased and SVR is increased. Peak inspiratory pressures rise. Renal vessels will be compressed, which reduces flow to the kidneys, and activates the renin angiotensin aldosterone system (RAAS). Reduced blood to the kidney means reduced urine output. Peak inspiratory and plateau pressures will also increase. The gas used to insufflate the peritoneum is CO2 – so, as you might guess, hypercarbia can develop – and with it, acidosis. You’ll see this sometimes reflected in the end-tidal CO2. This is all adding to the stress response we try to avoid in anesthesia.

A Peritoneal Dialysis (PD) Catheter is placed for dialysis that uses the lining of the abdomen, or belly, to filter your blood inside your body. This catheter permits dialysis fluid to be instilled into, and then removed from the abdomen. This is a preferred type of dialysis if a person cannot tolerate hemodialysis as it does not affect blood pressure as much and can be done at home.