E. Procedure (Also Refer to Chapter 26

and Abdominal Paracentesis Video

on the Procedures Website)

The ideal technique is surgical insertion of a permanent

peritoneal dialysis catheter, which can be placed by an

experienced surgeon in the neonatal intensive care unit (15).

Catheters placed to exit the skin in a caudal direction. carry a

lower risk of peritonitis. The catheter is tunneled from the

peritoneum to an exit site on the skin; it usually works well

and leaks infrequently (Quinton Pediatric Tenckhoff

Neonatal 31-cm catheter, Kendall Healthcare, Mansfield,

Massachusetts) However, if surgical insertion of a permanent

catheter is not possible, an alternative approach is to utilize

an angiocatheter or a temporary PD catheter for no longer

than a few days to minimize infection risk. Note that surgically inserted catheters are associated with fewer acute complications (16). With catheters inserted at the bedside,

guidewire-inserted femoral catheters have shown the least

mechanical complications; IV catheters produce more

mechanical complications than femoral catheters, but less

than catheters with stylets (17,18).

1. Monitor vital signs.

2. Restrain infant in supine position.

3. Scrub.

4. Prepare the skin of the abdomen (Chapter 5).

5. Drape to expose the insertion site.

The choice of insertion site is influenced by the

preference of the physician and/or the presence of postoperative wounds, abdominal wall infection, or organomegaly. A location one-third the distance from the

umbilicus to the symphysis pubis in the midline or a

site lateral to the rectus sheath in either of the lower

quadrants is preferred.

6. Infuse approximately 0.5 mL of lidocaine around the

insertion point.

7. Select either a 14-gauge angiocatheter or a temporary

dialysis catheter.