Page 684 - Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice

Peritoneal Dialysis 671

for short-term use often is chosen. After a catheter has
been selected, the animal is placed in dorsal recumbency,
and the abdomen is shaved and scrubbed for a surgical
procedure. It is essential that the animal be draped and
an aseptic technique maintained to prevent contamina-
tion of the peritoneal catheter system. The simple tube
catheters are placed by trocar. Using aseptic technique,
the catheter (over the trocar) is inserted through a stab
incision 3 to 5 cm lateral to the umbilicus oriented
toward the pelvis (Figure 28-8). 24,53 The trocar is
tunneled subcutaneously for several centimeters before
being inserted through the abdominal muscles into the
abdomen. The catheter then is threaded over the trocar
until fully in the abdomen. 24 The subcutaneous tunnel
ideally should create a snug fit, but a purse-string suture
Figure 28-7 A surgically implantable catheter design.
An omentectomy is required for optimal use. (The coaxial design should be placed to secure the catheter, and a tape butter-
by Global Veterinary Products, Spencer, Ind.) fly can be added to secure the catheter to the skin on the
lateral abdomen. Sutures have been reported to promote
tunnel infections in human patients; therefore for long-
term use it is recommended that a catheter with Dacron
cuffs be used and no purse-string suture placed. If a

A B

C D
Figure 28-8 Placement of a percutaneous dialysis catheter. A, A stab incision made 3 cm lateral to the
umbilicus. B, The catheter with trocar is inserted through the stab incision. C, Once inserted the catheter
and trocar are directed toward the pelvis. D, Once the catheter is fully inserted the trocar is removed.