Der PD-Katheter – Welcher, wann und wie?

Zur Durchführung der Peritonealdialyse kommen verschiedene, meist aus Silikon gefertigte Katheter zum Einsatz. Die Katheter unterscheiden sich in Form, Länge und der Anzahl sogenannter Cuffs. Manche Katheter weisen im Bereich des intraperitonealen Anteiles Distanzringe auf. Augenblicklich kann davon ausgegangen werden, dass die auf dem Markt befindlichen Katheter medizinisch gleichwertig sind, auch wenn Metaanalysen einen Vorteil der gestreckten gegenüber den gecurlten Modellen aufzuzeigen scheinen. PD-Katheter können auf verschiedene Weise implantiert werden. Das am häufigsten genutzte Verfahren ist die offene chirurgische Implantation. Mittlerweile werden auch viele PD-Katheter laparoskopisch oder laparoskopisch-assistiert implantiert. Viele verschiedene Varianten der operativen Vorgehensweise sind beschrieben. Die meisten der bislang durchgeführten Untersuchungen belegen hinsichtlich des Katheterüberlebens bzw. katheterassoziierter Komplikationen eine Gleichwertigkeit der Implantationsverfahren. Wenn auch nicht zwingend, so sollte der Zeitpunkt der Katheterimplantation nach Möglichkeit so gewählt werden, dass mindestens 2 Wochen bis zur Aufnahme der Dialysebehandlung zugewartet werden kann („break-in period“).

Peritoneal dialysis treatment requires the insertion of a peritoneal catheter. Available catheters are mostly made of silicon and differ in size, design and the number of cuffs. In some catheters, discs are fixed to the proximal part to allow spatial distance to the surrounding bowel. So far, different designs of PD catheters do not influence catheter survival or complications, although some meta-analyses do suggest that straight catheters do better than curled ones. There are different ways for PD catheter implantation. Most frequently, open surgery is used. However, there is growing experience in laparoscopic or laparoscopic-assisted techniques. No advantage regarding catheter survival or complications of one over the other technique could clearly be shown so far. If ever possible, timing of implantation should allow for a 2 weeks break-in period to ensure proper healing and to avoid early mechanical complications.

Key words

peritoneal dialysis - catheter - insertion - cuff - surgery

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