A new technique for insertion of the Tenckhoff peritoneal dialysis catheter

To eliminate the discomfort caused by surgical methods and the risks involved using the trocar, for 1 year we have been using a new technique for insertion of peritoneal catheters (PC). We devised a steel instrument, vaguely resembling a rhinoscope, composed of two semicones. The handles are connected by a screw to permit dilatation of the semicones. After local anesthesia, an introducer needle is inserted into the peritoneal cavity. A guide-wire is passed through the needle which is then withdrawn and our instrument is placed around the guide and gently pushed into the peritoneal cavity. The guide is now removed and squeezing the handles of the instrument we introduce the PC up to 2 cm beyond the first Dacron cuff. When the catheter is in place, the instrument is removed and a subcutaneous tunnel may be made. We have used this method for 25 patients. 14 were new cases while 11 underwent PC repositioning. For all patients this new method proved to be excellent with practically no leakage and PC were utilized immediately or after only 24 h. We emphasize the brief time for PC insertion, the minimum discomfort and the simplicity of the technique.