Name of the Procedure:

Insertion of Tunneled Intraperitoneal Catheter (e.g., for dialysis, intraperitoneal chemotherapy instillation, or management of ascites), complete procedure, including imaging guidance, catheter placement, contrast injection when performed, and radiological supervision

Summary

The insertion of a tunneled intraperitoneal catheter is a medical procedure where a flexible tube (catheter) is placed into the peritoneal cavity (area within the abdomen). This procedure uses imaging guidance to ensure correct placement and includes the injection of contrast material for better visualization. The catheter is tunneled under the skin to reduce infection risk. This catheter may be used for dialysis, administering chemotherapy directly into the abdomen, or draining excess fluid (ascites).

Purpose

This procedure addresses conditions requiring direct access to the peritoneal cavity, such as renal failure needing dialysis, cancer treatments requiring intraperitoneal chemotherapy, or severe ascites causing discomfort and medical complications.

Indications

• Renal failure requiring peritoneal dialysis
• Abdominal cancers requiring intraperitoneal chemotherapy
• Severe ascites causing abdominal pain, difficulty breathing, or risk of infection
• Patients who need a long-term solution for fluid management or drug administration into the peritoneal cavity

Preparation

• Fasting for several hours before the procedure may be required
• Blood tests and imaging studies to assess the abdominal area
• Review and adjustment of current medications, particularly blood thinners
• Pre-procedure consultation to discuss risks, benefits, and consent

Procedure Description

1. The patient is positioned, and local or general anesthesia is administered.
2. Using imaging guidance (usually ultrasound or fluoroscopy), a small incision is made near the abdomen.
3. A tunnel is created under the skin to place the catheter, which is then inserted into the peritoneal cavity.
4. Contrast material may be injected to confirm the correct placement.
5. The external end of the catheter is secured, and the incision sites are closed and dressed.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

The procedure is usually performed in a hospital or an outpatient surgical center.

Personnel

• Interventional radiologist or surgeon
• Nursing staff
• Anesthesiologist (if general anesthesia is used)
• Radiology technician

Risks and Complications

• Infection at the incision site or within the peritoneal cavity
• Bleeding or bruising
• Catheter blockage or malfunction
• Injury to surrounding organs
• Pain or discomfort at the site of insertion
• Allergic reactions to contrast material

Benefits

• Effective management of chronic conditions like renal failure and severe ascites
• Direct delivery of chemotherapy for better targeting of abdominal cancers
• Long-term solution with reduced risk of infection due to tunneled design
• Improved patient quality of life and comfort

Recovery

• Post-procedure monitoring in a recovery area for a few hours
• Instructions on catheter care, hygiene, and signs of infection
• Pain management guidelines
• Restrictions on strenuous activities for a few days
• Scheduled follow-up appointments to assess catheter function and address any issues

Alternatives

• External peritoneal catheter for short-term use
• Traditional hemodialysis for kidney failure (for those suitable for this method)
• Systemic chemotherapy for cancer (instead of intraperitoneal)
• Paracentesis for one-time drainage of ascites (for non-recurrent or low-volume ascites)

Patient Experience

• Mild discomfort or pain at the insertion site, managed with medications
• Sensation of pressure or movement during the contrast injection
• Post-procedure tenderness and instructions to avoid heavy lifting or strenuous activities
• Aftercare includes daily catheter hygiene and monitoring for signs of infection.