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Author Topic: Anesthesia choices for PD catheter placement?  (Read 2479 times)
Sax-O-Trix
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« on: January 17, 2011, 04:18:16 PM »

 I just researched a little bit on PD catheter placement surgery and was wondering about anesthesia choices.  I do not want general if at all possible, but am a huge wimp and don't want a local (needles being stuck in my abdomen is more than I can bear to think about.)  Perhaps EMLA cream would ease the needle insertion pain, idk.  I also read there are different techniques to have the surgery done.  Which one should I ask for? What do you think is the best way to have this procedure done?
« Last Edit: January 17, 2011, 04:53:55 PM by Sax-O-Trix » Logged

Preemptive transplant recipient, living donor (brother)- March 2011
peleroja
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« Reply #1 on: January 18, 2011, 07:39:09 AM »

I wasn't given a choice either time.  They gave me a general, which I hate because of the tube they stick down your throat.  You end up with a dry throat every time.  It sucks.
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Sax-O-Trix
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« Reply #2 on: January 18, 2011, 02:40:21 PM »

This is what I found...

Catheter placement is a quick (15-30 minute), minor procedure. It should be done in an operating room to help prevent infection. If you are nervous, ask about drugs to help you relax or sleep. You won't be able to eat after midnight, so you may want to set up your visit for the morning. The nurse or doctor will draw on your skin with a marker to show where the catheter will go. Some centers will require you to have an enema and/or take a shower before the placement. Just before the procedure, you will need to empty your bladder.

There are four ways to place an abdominal PD catheter:1

Surgical - This is the most often used technique. You will be given local (just the area) or light general anesthesia. A scalpel is used to open the skin and muscle. Then, a tiny (1-2 cm) cut is made through the wall of the peritoneum (the lining of the abdomen). Some omentum (a curtain of tissue inside the abdomen) may be pulled out and removed so it does not get in the way of the catheter. The catheter is pushed through the cut, which is then stitched around it. The exit site is chosen, and a tunneling tool is used to form a place for the catheter under the skin. The catheter is pulled through the tunnel until the cuff is in place. Then stitches are placed around it. Surgery is more costly and makes a larger incision than other techniques.
Trocar - Using local anesthesia, a small (2-3 cm) cut is made through the skin and muscle. PD fluid will be placed in your abdomen using a needle or tube. Then, the surgeon will ask you to tense your stomach muscles while a trocar (pointed tool) is inserted. The trocar is removed, leaving guides to help the surgeon place the catheter and stitch it in place. Then a tunnel is made under the skin to an exit site, and stitches are placed around it. Since the trocar makes a large hole, this technique may cause more leaking.1
Guide Wire - Using local anesthesia, a small (1-2 cm) cut is made through the skin and muscle. You will be asked to tense your stomach muscles so the surgeon can push a small tube through the peritoneum. PD fluid will be placed in your abdomen. The surgeon will insert a guide wire through the tube, and use the wire to place the catheter in the right spot. Then a tunnel is made under the skin to an exit site, and stitches are placed around it. This technique may cause less leaking, but there is a risk that the bowel could be perforated by the small tube.1
Scope - Using local anesthesia, a small cut is made through the skin and muscle. A mini-trocar with a thin tube inside is inserted through the wall of the abdomen. The trocar is removed, and a scope is inserted so the surgeon can see the inside of your abdomen. The catheter is placed and stitched, and then the guide is removed. A tunnel is made under the skin to an exit site, and stitches are placed around it. A surgeon needs special training to use the scope.
Some surgeons keep the catheter under the skin for two weeks or more, instead of making an exit site. When it is time to start PD, a small cut is made to pull the catheter out. This is called the Moncrief-Popovich procedure. Research suggests that this technique helps catheters last longer and helps prevent infection.2

Any comments?

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Preemptive transplant recipient, living donor (brother)- March 2011
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« Reply #3 on: January 18, 2011, 02:49:41 PM »

Well I couldn't tell you which method they used on me, but they didn't give me a choice;  they just put me all the way to sleep.  I would recommend that if it's an option because it was really easy.  It seemed like I had barely shut my eyes and then it was over. 
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Lillupie
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« Reply #4 on: January 19, 2011, 08:15:29 PM »

Well I couldn't tell you which method they used on me, but they didn't give me a choice;  they just put me all the way to sleep.  I would recommend that if it's an option because it was really easy.  It seemed like I had barely shut my eyes and then it was over.

I totally agree here. The other options sound horrible, and for something like a PD cathater, no matter how minor it is, I would not do it any other way besides general, in the operating room.

Lisa
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« Reply #5 on: January 19, 2011, 08:21:19 PM »

I'm not on PD but I can tell you any surgery involving something with dialysis they do a twilight to me using versaid and of course a local.
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« Reply #6 on: January 20, 2011, 03:12:35 PM »

For a pd catheter it done under a general.
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