When faced with a poorly performing or nonfunctional peritoneal dialysis catheter, there is a very simple trick to make laparoscopic exploration easier. Prep the catheter into the field and take extra care to prep the cover of the catheter. It is usually easier to remove the extended portion of the catheter (A) and just leave the shorter piece (B).
Access the catheter and gently inject a few cc’s of saline to make sure the tubing has some degree of patency. This usually is not a problem. As long as some fluid will go in, the CO2 can now be attached directly to the malfunctioning PD catheter and insufflation undertaken. This makes accessing the previously scoped abdomen easier and safer, as the abdomen will already be distended when you place your first port. Pay attention to the pressures and flow as you would always do during insufflation.
As soon as the port is in, simply switch the CO2 over to it from the catheter. This technique comes in handy quite often, as many patients with difficult PD catheters have undergone multiple explorations or laparoscopies. Not rocket science, but it can definitely save you and the patient some difficulty!
Dr. Rigberg is Clinical Professor of Surgery and Program Director, University of California, Los Angeles, Division of Vascular Surgery, and an associate medical editor for Vascular Specialist.