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Initially the procedure is started by performing of local anesthesia. Antibiotic prophylaxis was administered with intravenous vancomycin (1 g) injected 2 h before to the procedure. Patients received intravenous fentanyl (1 μg/kg) or propofol (1 mg/kg) and local anesthesia (2% lignocaine).
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A horizontal paramedian small incision of 2-3-cm long was made and then follows by a blunt dissection of subcutaneous tissue til the fascia of the rectus muscle. The peritoneum is puncture by means of a 16-gauge needle through a kit called Quinton-catheter placement kit. The exact location of the guidewire was established with fluoroscopy using a image intensifier.
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A peel-away sheath and introducer were inserted on the guidewire. The introducer was detached along with the guidewire by parting the peel-away sheath in situ. The PDC was higher through the peel-of sheath and is directed caudally in the direction of the left iliac fossa and thus splitting the peel-of sheath.
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The exact place of the PDC was reconfirmed with fluoroscopy to confirm its correct position in the pelvis. The inside cuff of PDC was protected by a suture on the fascia of the rectus muscle. An 8-12 cm of subcutaneous tunnel for the PDC was fashioned by means of a stylet.
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The proximal end of the PDC were pull by the exit site and located in a manner in such a way that the inner cuff which was placed at peritoneal way in the fascia of the rectus muscle, and the 2nd cuff was 2 cm away from the exit site.
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The original cut or incisions were then blocked and the PDC was flush with 2 L of heparinized 2.5% dialysis liquid to confirm catheter patency and to examine the intra-abdominal bleeding. The line was then capped-off if there was considerable blood staining of the effluent. Suppose the latter occurs, hourly cycles were continues till the drained dialysate was plain.
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CAPD was initiated 3-7 days after PDC placement. Patient were trained during this period. Little volume supine exchanges (up to 250 ml) were regularly performed during the training, and patients are suggested to avoid constipation.
