A PD catheter is a soft, flexible silicone tube that sits permanently in your abdomen and allows fluid to flow in and out of your belly during peritoneal dialysis, a treatment for kidney failure. The catheter is about the width of a pencil, with one end resting inside the abdominal cavity and the other end exiting through a small opening in your skin. It serves as the lifeline for people who perform dialysis at home rather than going to a clinic for hemodialysis.
How a PD Catheter Is Built
The most widely used design is called a Tenckhoff catheter, named after the physician who developed it. It’s a single-tube device made from soft silicone, with multiple small side holes along the portion that sits inside the abdomen. These holes allow dialysis fluid to flow freely into and out of the peritoneal cavity, the space surrounding your intestines and other abdominal organs.
Along the shaft of the catheter sit one or two small felt-like cuffs made from synthetic material called Dacron. In adults, a double-cuff design is standard. The deeper cuff anchors into the muscle layer of the abdominal wall, holding the catheter in place as tissue grows into it over the weeks after surgery. The outer cuff sits just beneath the skin and acts as a barrier against bacteria traveling along the tube into your body. The space between the two cuffs creates a tunnel under the skin that adds another layer of protection against infection.
PD catheters come in several variations. The tip inside the abdomen can be straight or coiled, with coiled tips being somewhat less prone to blockage. The portion that runs under the skin can also be straight or curved in a permanent bend called a swan-neck design, which helps the external end of the catheter point downward. This downward angle may reduce the chance of exit-site infections. Studies comparing swan-neck catheters to straight ones have found better long-term technique survival with the swan-neck design, though both types perform similarly for overall patient outcomes. In practice, the choice depends on your body type and your surgical team’s experience.
What the Catheter Actually Does
Peritoneal dialysis uses the lining of your abdomen as a natural filter. The catheter is simply the delivery system. During each treatment cycle, a bag of dialysis solution (sterile water mixed with salt, sugar, and other additives) flows through the catheter into your belly. Once inside, the solution sits against the peritoneal membrane and draws waste products and excess fluid out of your bloodstream through that membrane. After a few hours, you drain the used solution back out through the same catheter into an empty bag, and the cycle starts again.
Some people do these exchanges manually several times a day, while others connect to a machine at night that cycles fluid in and out while they sleep. Either way, the catheter stays in place between treatments. The external portion hangs outside your body, typically taped to your abdomen and tucked under clothing.
How It Gets Placed
A PD catheter is inserted surgically, usually as an outpatient procedure. The most common approaches are laparoscopic surgery (using a small camera and tiny incisions) or a technique using a special needle-and-wire method called the Seldinger technique. In both cases, the surgeon threads the catheter through the abdominal wall so the perforated tip lands deep in the pelvis, where fluid can pool and drain most effectively.
After placement, most centers recommend a “break-in” period of at least two weeks before starting full dialysis. This gives the surgical sites time to heal and lets the Dacron cuffs bond with surrounding tissue, which strengthens the seal against infection and prevents the catheter from shifting out of position.
Common Complications
Infection is the biggest risk of living with a PD catheter. Problems fall into three main categories: peritonitis (infection of the abdominal lining), exit-site infections where the tube leaves the skin, and tunnel infections along the path under the skin. Peritonitis accounts for about 61% of catheter-related problems, with exit-site and tunnel infections making up another 23%. The remainder involves mechanical issues like blockage, catheter migration, or fluid leaking around the insertion site.
Quality standards set by the UK Renal Association call for no more than one peritonitis episode per 18 months per patient, though real-world rates vary widely, from 0.24 to 1.66 episodes per patient per year depending on the center. Peritonitis matters because for every half-point increase in the annual rate, the risk of death rises by roughly 4%. About 18% of peritonitis episodes lead to catheter removal, and 3.5% result in death.
When infections don’t respond to antibiotics within five days, or when fungal organisms are found in the drained fluid, the catheter typically needs to be removed. Relapsing infections and certain stubborn bacteria like Pseudomonas or Staph aureus that colonize the catheter itself are also grounds for removal. In many cases, a new catheter can be placed after the infection clears.
Daily Care and Maintenance
Keeping the exit site clean is essential. The International Society for Peritoneal Dialysis recommends dressing the site daily or every other day. A typical routine involves washing the exit site with antibacterial soap during a shower, patting it thoroughly dry with a clean towel, applying an antiseptic and a topical antibiotic cream, then covering the site with a sterile gauze dressing. Some centers allow patients to leave the site uncovered after cleaning and applying antibiotic cream, as long as the catheter is secured with tape to prevent tugging.
You should never touch the exit site or catheter connections without washing your hands first. The external catheter needs to be immobilized against your skin at all times to prevent pulling, which can damage the exit site and invite infection.
Living With a PD Catheter
A common concern is whether you can still shower, swim, or be active. Showering is fine and actually part of the daily care routine. Swimming is also possible with precautions. A survey of Australian dialysis centers found that 85% recommend swimming in sea water and 90% approve private swimming pools, as long as the exit site and catheter are covered with a waterproof film dressing or a colostomy bag. Routine exit-site care after swimming is universally recommended, and infections among swimmers are rarely reported.
The catheter sits flat against the abdomen and is easy to conceal under regular clothing. Most physical activities are possible, though contact sports and heavy lifting may need to be modified. The external portion of the catheter is typically 15 to 20 centimeters long, so securing it well prevents it from catching on clothing or getting pulled during movement.