My mom has had her catheter in place for about 6 weeks now and is having some issues. For one, she leaks around the catheter during every exchange. Also there is about 2 inches of play in the catheter that allows it to slide in and out of her abdomen. The surgeon says he can fix it with a stitch and a little glue. She hasn’t had any imaging to check placement and she says she feels like it is poking her in the bladder. Her drainage output is erratic and she has a fair bit of swelling in her feet and ankles. We aren’t feeling very confident about the glue plan. Any thoughts?
I would be concerned that the deep cuff of the PD catheter is not properly fixed or implanted. This would result in a poor seal between the catheter and the muscular layer of the abdominal wall and allow excessive movement of the catheter and leakage of dialysate around the catheter. The dialysate may be leaking into the tissues of the abdomen and contributing to the swelling experienced by the patient.
If this problem arose immediately after an adequate healing time of 2-4 weeks, a new PD catheter may need to be placed. If the PD catheter was used immediately, or soon after implantation, one could stop PD and wait for a couple of weeks to let the tract heal further. This unfortunately may not be an option if dialysis is needed.
I would not advise placement of a suture as this will only cause local irritation and does not fix the underlying concern about the deep cuff. Glue will not fix the problem.
Dr. Leslie Wong, MD
Medical Director, Peritoneal Dialysis Program
Northwest Kidney Centers, Seattle, WA
Dr. Wong is answering PD questions in this forum during the month of September.
Thank you for your input. We took mom to another surgeon who is much more experienced with PD catheters and he suspects that the problems are coming from the fact that the inner cuff does not have a muscular layer to anchor in (because of a previous post-mastectomy tram flat reconstruction procedure she had 8 years ago). He recommends removing the catheter and placing a new one on the other side of her belly. We’re so glad we got the second opinion. Thank you so much for your help!
-grateful concerned daughter