ABSTRACT
The peritoneal catheter is a lifeline for the peritoneal dialysis patient. Still the most widely used catheter for continuous ambulatory peritoneal dialysis (CAPD), the double-cuff silicone Tenckhoff catheter was developed in 1968 for treatment of patients with intermittent peritoneal dialysis (1). Catheter-related complications are increased in CAPD due to higher intra-abdominal pressure and numerous daily manipulations. Modifications of catheter design, placement techniques, meticulous postoperative care, and a standardized break in procedure have contributed to overall increased longevity, better catheter function and a reduction in catheter-related complications such as catheter-tip migration, dialysate leaks, and exit-site infections. Catheter exit-site and tunnel infections are, however, frequent in patients on CAPD and are the major causes of increased morbidity, prolonged antibiotic therapy, recurrent peritonitis, and catheter failure. A 1987 National CAPD registry report mentioned that 12.4% of catheters are removed because of exit or tunnel infection (2). This chapter will present practical aspects of complications and the management of peritoneal access in both acute and chronic peritoneal dialysis.
