Page 682 - Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice

Peritoneal Dialysis 669

PROTOCOL FOR and subcutaneous layers become anchored by ingrowth
6,64
PERITONEAL DIALYSIS of fibroblasts. The fluted aspect of the catheter is
placed against the parietal peritoneum and oriented in a
cranial to caudal plane. The catheter is flexible and
CATHETER TYPES AND PLACEMENT designed to temporarily fold at the crosspiece to facilitate
The key to successful PD is the catheter and its placement. insertion. The fluted aspect of the catheter is 30 cm in
An ideal catheter allows efficient inflow and outflow, is
biocompatible, resists infection of both the peritoneum BOX 28-3 Suppliers of Peritoneal
and subcutaneous tunnel, and retards leakage at the peri- Dialysis Catheters
toneal exit site. 18 One of the most common causes of
catheter failure in small animals is catheter obstruction
by omentum, resulting in failure to drain dialysate from Medigroup, Inc.
the abdomen. There are many catheter designs available 505 Weston Ridge Drive
(Box 28-3), and most are modifications of a fenestrated Naperville, IL 60563-3932
800-323-5389
silicone tube with Dacron (Invista, Wichita, Kan.) cuffs
630-428-4148 (fax)
applied to promote fibrous attachments at the peritoneal
www.medigroupinc.com
and cutaneous exit sites (Figure 28-3). Simple tube
Ash Advantage Peritoneal Catheter
catheters with stylets can be placed percutaneously in Adult, standard
conscious animals using local anesthetics in an emergency Flex-Neck Peritoneal Catheter
situation. 23,24,53 A percutaneous cystotomy tube catheter Coiled Adult Standard and Large
(Stamey percutaneous suprapubic catheter set, Cook, Kendall Healthcare/Kendall Vascular
Spencer, Ind.) also has been used successfully for acute 15 Hampshire Street
short-term PD (Figure 28-4). The Tenckhoff catheter, Mansfield, MA 02048
developed in 1968, is a straight soft Silastic tube 800-962-9888
www.kendallhq.com
fenestrated at the distal end and furnished with two
Dacron velour cuffs. 65 Because of the high rate of omen- A variety of peritoneal dialysis catheters
Medcomp
tal entrapment, surgical omentectomies are advocated
1499 Delp Drive
when using this catheter in animals in which more than Harleyville, PA 19438
3 days of dialysis is anticipated. 12,23,24 PD for acute renal 215-256-4201
failure should be performed for a minimum of 48 to 72 www.medcompnet.com
hours, but the animal’s condition often necessitates a lon- Straight and curled, one and two cuff peritoneal dialysis
ger period of treatment. catheters
An alternative catheter style called the fluted-T (Ash Cook Surgical
Advantage peritoneal dialysis catheter, Medigroup, P.O. Box 489
Aurora, Ill.) has produced good results in dogs 750 Daniels Way
(Figure 28-5). In one study, 17 dogs had fluted-T Bloomington, IN 47402-0489
catheters placed by peritoneoscope and were dialyzed 812-339-2235
800-457-4500
daily. Only four catheters had outflow failure that
www.cooksurgical.com
occurred 7 to 18 days after placement. The remaining
Acute and chronic peritoneal dialysis catheters, Tenckhoff
catheters functioned for the entire study period of 60 and Spiral
days. 6,64 In the same study, Tenckhoff catheters in the Global Veterinary Products, Inc.
dogs were obstructed by omentum 2 to 4 days after 19601 West U.S. Highway 12
placement. New Buffalo, MI 49117
The flutes are designed to offer minimal resistance to 269-469-8882
influx and efflux of fluid while preventing omental adhe- 269-469-9940 (fax)
sion. The design of this catheter prevents outward migra- www.globalvetproducts.com
Acute peritoneal dialysis catheter, coaxial design
tion. There is diminished hydraulic resistance during
Cook Urological Incorporated
inflow and outflow because most of the dialysate flow
1100 West Morgan Street
pathways are around the catheter rather than within it.
P.O. Box 227
There is more complete drainage of the peritoneum
Spencer, IN 47460
through the limbs of the catheter, which are directed both 812-829-4891
cranially and caudally in the abdomen. Any residual 800-457-4448
omentum appears to have more difficulty attaching to 812-829-2022 (fax)
the slots in the catheter than to the small holes in more www.cookurological.com
traditional catheters. This silicone catheter has two Stamey percutaneous suprapubic catheter
Dacron cuffs that when implanted in the rectus muscle