Percutaneous peritoneal dialysis catheter placement combined with the SMAP technique

Abstract

In Japan, peritoneal dialysis catheter placement is mainly performed via a mini-laparotomy; therefore, percutaneous catheter insertion is rare. In this study, we conducted percutaneous peritoneal dialysis catheter insertion combined with the stepwise Moncrief and Popovich (SMAP) technique in 2 patients, which produced good outcomes. Using a Veress needle or cannula needle, the abdominal wall was punctured under ultrasound guidance, and the peritoneum was penetrated. A guidewire was advanced to the pelvic floor under fluoroscopy, and then a peel-away sheath was inserted into the abdominal cavity. The peritoneal dialysis catheter was indwelled from the sheath. The internal cuff was positioned within the subcutaneous fat on the rectus abdominis muscle, and the catheter was embedded in the subcutaneous tissue. An exit site was created and peritoneal dialysis was started after 3 and 6 months, respectively, but no leakage was observed. Percutaneous peritoneal dialysis catheter insertion is a minimally invasive technique and can be performed under local anesthesia. Furthermore, when combined with the SMAP technique it is effective at preventing liquid leakage.