A PD catheter, the only type of dialysis access used for PD, is placed through your abdomen and into the peritoneal space through the peritoneal membrane.

Peritoneal dialysis (PD) works by using your own abdominal lining (peritoneum) as a natural filter to clean your blood, using a special sugary fluid (dialysate) that flows into your belly via a catheter, stays for a few hours to absorb wastes and extra fluid, and then drains out, removing toxins from your body. This process, called an exchange, involves three steps: fill, dwell, and drain, repeated throughout the day or overnight, either manually ( CAPD ) or by a machine ( APD ).

Percutaneous Techniques for PD catheter insertion: 

Placement of PD catheters with a guide wire and peel-away sheath is performed using a Seldinger technique. The procedure can be performed under local or general anaesthesia with prophylactic antibiotics. A small incision is created above the entrance site, usually in the midline with blunt dissection of the abdominal rectus sheath. The peritoneal cavity is cannulated with an 18-gauge needle and filled with either air or 500 ml of saline. With proper needle placement, the patient should not experience pain or resistance to fill the cavity with fluid. A 0.035-inch guide wire is advanced into the abdomen and the introduction needle is removed. A dilator and the peel-away sheath are advanced over the wire into the abdominal cavity. The wire and the dilator are removed and the catheter is placed on the stylet, advanced through the sheath. The intraperitoneal segment is advanced until the proximal cuff is located in the preperitoneal space. The peel-away sheath and stylet are removed and the catheter position is checked. A tunnel is created to the selected exit site with the placement of the distal cuff subcutaneously, 2 cm from the exit site. The entrance site is closed. The abdomen is filled with 500 ml of saline and drained. 

PD catheter insertion procedure conducted by Prof. Dr. M. A. Samad, President, Bangladesh Society for Peritoneal Dialysis.

BSPD- Bangladesh Society for Peritoneal Dialysis, PD – Peritoneal Dialysis, CAPD – “Continuous Ambulatory Peritoneal Dialysis” is manual, done several times daily, allowing daytime freedom but needing active patient participation, while APD – “Automated Peritoneal Dialysis” uses a machine overnight (cycler) for automated exchanges, during night sleeping