Peritoneal access

For acute peritoneal dialysis a trochar and cannula are inserted through a small skin incision under local anaesthetic. The skin is prepared and draped as for any sterile procedure. The commonest approach is through a small midline incision 1cm below the umbilicus. The subcutaneous tissues and peritoneum are punctured by the trocar which is withdrawn slightly before the cannula is advanced towards the pouch of Douglas. In order to avoid damage to intra-abdominal structures 1-2l warmed peritoneal dialysate may be infused into the peritoneum by a standard, short intravascular cannula prior to placement of the trocar and cannula system. If the midline access site is not available an alternative is to use a lateral approach, lateral to a line joining the umbilicus and the anterior superior iliac spine (avoiding the inferior epigastric vessels).

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