CAPD rev.pptx peritoneal dialysis ppt pwer point

ppt

1. Laparoscopic Peritoneal Dialysis Catheter Insertion

2. Introduction Dialusis (Greek) = to separate Catheters (from Greek kathienai = to send down, to introduce) Peritoneal dialysis indicates removal of toxins from the blood through the peritoneal membrane

3. History about 30 AD , Celsus insert bronze tube to the peritoneal cavity: “in those who are dropsical( odema / Acites ) the water ought to be let out,” 1923: Ganter from Würzburg: The first peritoneal dialysis in humans for the purpose of treatment of uremia 1936, Rhoads : The first intermittent peritoneal dialyses in humans were performed 1946 Frank , Seligman and Fine :To help maintain patency of the irrigating catheters in long term experiments, omentectomy was performed ( a dog mode) 1968, Henry Tenckhoff and H. Schechter : Introduce The Tenckhoff catheter and later became the gold standart . 1960: Double lumen catheters early 1990s: Laparoscopic insertion of PD catheters was first described

4. Absolute Contraindications Documented loss of peritoneal function such as ultrafiltration failure of the peritoneal membrane In the absence of a suitable assistant, impaired physical and mental ability of the patient to safely use Severe protein malnutrition and or proteinuria > 10 g / day Active intraabdominal, abdominal wall or skin infection

5. INSERTION OPTIONS

6. Why should I do Laparoscopic procedure?

7. What Can I do During Laparoscopic Procedure Omentectomy Catheter Fixation to the Abdomen wall Lysis of Adhesions Other Procedure

8. Placement of a Peritoneal Dialysis Catheter With Routine Omentectomy—Does it Prevent Obstruction of the Catheter?

9. Laparoscopic Peritoneal Dialysis Catheter Implantation With an Intra-abdominal Fixation Technique

10. Dialysis process

11. Preoperative preparation Explanation of the procedure Shower Removal of body hair Empty the bladder or Foley Catheter insertion Prophylactic antibiotic

12. SURGICAL TECHNIQUE Peritoneal Access: open Hassan trocar (recommended if prior abdominal incision) and Veress needle Equipment: Standard laparoscopes, there is no standard number of ports, ultrasonic dissecting instruments, nonabsorbable suture for catheter fixation. Catheter options: Commonly used catheters are silicone and have a pig tail or straight Trocar position: trocar position varied, Generally one port is used for the camera in the mid or upper abdomen and at least one more lateral port is used for grasping instruments

13. SURGICAL TECHNIQUE Insertion through the abdominal wall:During the implantation the deep cuff is placed in between the anterior and posterior rectus sheaths Exit site and subcutaneous tunnel:After the deep cuff is placed, the end of the catheter is tunneled subcutaneously to an exit site in the lateral abdominal wall The superficial cuff is 2 cm or greater from the exit site to prevent cuff extrusion

14. Catheter type

15. Catheter tenckhoff

16. Diagram of tenckhoff catheter position

17. Tenckhoff catheter Position

18. SITE PLAN

19. POSTOPERATIVE PROTOCOL The dressing should not be changed more than once a week during the first two weeks unless bleeding occurs or Infection is suspected. Peritoneal dialysis should not be commenced until at least 2 weeks after the insertion of the dialysis catheters

20. Conclusion No Advantage Disadvantage 1 Visualisation of the abdominal cavity and placement tip of the catheter More incisions 2 Allow for adjunct procedures Require general anesthesia 3 Lysis of adhesions and omentectomy Longer Procedure 4 Possible suture fixation More equipment 5 Lower tips migration and higher survival rates Need experienced