Advantages and disadvantages of surgical placement of PD catheters with regard to other methods.

Peritoneal dialysis is underused for various reasons. One reason may be problems with insertion of catheters for access. Another reason is the delayed start (break-in period) of about 2 weeks after operation. This review describes various approaches to the insertion of a peritoneal dialysis catheter. The optimal conditions to strive for are given as is an overview of various techniques. This article favours surgical placement while others might prefer other techniques. Described is the use a 3-purse string suture technique that allows immediate start of dialysis after catheter insertion both for acute dialysis indications as well as for acute start in chronic dialysis patients. A key to lesser complications is to establish a team devoted to the insertions rather than to allow various physicians to perform insertions as a training procedure. An optimal access is one of the important life lines for these patients.