Before your child starts peritoneal dialysis, a Tenckhoff catheter must be placed inside their abdomen by a specialist surgeon. Caring for your child’s Tenckhoff catheter will become part of your family’s daily routine. Ask your child’s care team any questions you have.
The peritoneal cavity
The peritoneal cavity contains many internal organs such as the stomach, liver, intestines and bladder. Inside this space, a membrane (thin film of tissues) forms a sack around these organs and keeps them all in place. The tip of the Tenckhoff catheter lies low in your child’s pelvis, between the bladder and the rectum. The place where the catheter comes out of the abdomen is called the exit site. The catheter will stay in your child’s abdomen for as long as he/she needs peritoneal dialysis.
What does the Tenckhoff catheter do?
The Tenckhoff Catheter has many small holes in it for dialysis fluid to run in and out of your child’s abdomen. Dialysis fluid contains sterile water, salts and sugar (glucose). This fluid draws out waste products and water from the blood vessels covering the surfaces of the peritoneal membrane, acting like a filter. This is usually done at night while your child is asleep and connected to a dialysis machine.
We will try to put your child’s Tenckhoff catheter in two to three weeks before starting dialysis. This gives the wound plenty of time to heal. It also helps prevent complications such as leaks or infection. Occasionally, the catheter needs to be used sooner after surgery.
Your child’s surgery
Your child may be required to stay in hospital overnight and remain until he/she has met the expected recovery outcomes. Ask your child’s nurse about these.
Please bring a list of all the medicines your child is taking. This includes herbal or homeopathic tonics. Most medications can continue as usual.
An anaesthetist will see your child before they have surgery. The anaesthetist will discuss the following with you and your child:
- The choice of anaesthetic.
- Whether it would be helpful for you to stay with your child as the anaesthetic begins.
- What kind of pain-relieving medicine he or she will require after your child wakes up.
- What happens if your child is feeling sick or vomiting after the operation.
- Previous experiences with anaesthesia and surgery.
- Medicines your child is currently taking.
When it is time for your child’s operation, their nurse will take them to the operating suite. You may walk with or carry your child.
What to expect after surgery
After the operation, your child will be transferred to the post anaesthetic care unit. A nurse will call you when you can sit with your child. It is important for you to be there when your child ‘wakes up’ as they will need to see your familiar face. Please be aware that it can be distressing to see your child waking from anaesthetic. Your child may be sleeping, crying or be quietly awake. Often children will begin to cry when they see a parent/ familiar face. When it is safe to do so, your child will be transferred to their room.
After the operation your child will have fluids and pain medicine as discussed with the anaesthetist prior to surgery. Your child will have a dressing over the exit site area of the catheter. You may also notice another cut, not too far away from the exit site. This cut will have been closed with dissolvable stitches which dissolve over the next 10 to 14 days.
Your child’s nurse will assess them and record their temperature, heart rate, respiratory rate and blood pressure. They will also check any medicines, the Tenckhoff tubing, and the site of the intravenous drip. The exit site dressing will be checked for excessive bleeding or bruising. They will also check if your child’s needs any pain-relieving medicine.
Your nurse will assess your child frequently after the operation, and will wake them throughout the night to do so. Don’t be alarmed – this is normal and important to your child’s progress. The team of doctors who operated on your child will also review them.
When your child is fully awake after the surgery, he or she is able to have clear drinks (ice chips, water, and ice blocks). Your child’s normal diet may resume gradually once he or she is tolerating drinks/fluids.
Your child may have an intravenous drip overnight. This will be removed when they can tolerate food and fluids.
Please ask the nurse before giving your child anything to drink or eat as they will be recording the amounts that your child is drinking and eating.
If your child feels sick or vomits after surgery, tell their nurse so that anti-nausea medicine may be provided.
It is important that your child is comfortable and his or her pain is controlled following the operation. The nurse will regularly assess your child’s comfort and pain. It is very important to help the nursing staff understand when your child is experiencing pain.
A doctor from the renal team will see your child before they are discharged.
Your child will be ready for discharge when:
- their observations are within normal limits
- they are tolerating food and fluids
- they are able to walk without assistance
- they have effective control of pain with oral analgesia (tablets/medicine)
- you feel confident with the home care of the Tenckhoff Catheter.
Before your child is discharged, a renal nurse will talk to you about caring for your child and the Tenckhoff catheter at home.
Care at home
The dressing will need to stay in place for two weeks to ensure the wound is well healed before the catheter is used. You will need to give your child a sponge bath during this time to avoid getting the dressing wet.
Swimming is not recommended with a Tenckhoff catheter. Please discuss this with your nephrologist at your next outpatients appointment.
An appointment will be made for you to bring your child to the hospital seven and 14 days after their operation to have the dressing checked and the catheter flushed.
An appointment will also be made to see the doctor in renal clinic. It is very important that you return for these visits to make sure your child’s catheter and dressing are cared for properly.
After two weeks, you will be taught how to look after your child’s Tenckhoff Catheter at home to make sure that it works well and does not become infected.
If your child tends to have constipation, tell the renal nurse or doctors as it can cause problems when peritoneal dialysis is started.
Seek medical help immediately if
- the dressing gets wet, soiled or lifts off.
- the cap falls off the end of the catheter
- (use the white clamp provided with catheter so that the germs can not enter your child’s abdomen).
- your child runs a fever.
- your child complains of abdominal pain, vomiting or diarrhoea.
Nephrology Clinical Nurse Consultant
Queensland Children’s Hospital
501 Stanley Street, South Brisbane
t: 3068 1111 (general enquiries)
In an emergency, always call 000.
If it’s not an emergency but you have any concerns, contact 13 Health (13 43 2584). Qualified staff will give you advice on who to talk to and how quickly you should do it. You can phone 24 hours a day, seven days a week.
How To Care For Your Tenckhoff Catheter After Your Operation, Peritoneal Dialysis Unit, Princess Alexandra Hospital, Brisbane. 2006
Take Control—Training Manual for Patients on Peritoneal Dialysis, Baxter Healthcare, 2005
Patient Education Programme—kidney options guiding you when your kidneys fail. Fresnius Medical Care. 2008
Tunnel and peritoneal catheter exit site infections in continuous peritoneal dialysis. Up to date. 2011
IPSD Guidelines/Recommendations Peritoneal Dialysis—Related Infections Recommendations. 2005 Update
IPSD Exit Site Care in Australian Peritoneal Dialysis Centres—A Nationwide Survey. 2009