A peritoneal dialysis catheter is a soft, flexible tube placed into your abdomen that allows dialysis fluid to flow in and out of your belly, filtering waste from your blood when your kidneys can no longer do the job. Unlike hemodialysis, which requires trips to a clinic and connection to a large machine, peritoneal dialysis happens inside your own body, and the catheter is the permanent access point that makes it possible. Most catheters stay in place for years, with survival rates around 80% at one year and 72% at two years.
How the Catheter Is Built
The standard peritoneal dialysis catheter is called a Tenckhoff catheter, named after the doctor who designed it. It’s a hollow silicone tube, roughly the diameter of a pencil, with small holes along the tip that sits inside your abdominal cavity. These holes allow dialysis fluid to flow freely in both directions.
The catheter has two felt-like cuffs made of a material called Dacron. These cuffs serve as anchors. The deep cuff sits within the abdominal wall muscle, and the superficial cuff sits just under the skin, about 2 centimeters from where the tube exits your body. Over several weeks, your tissue grows into these cuffs, locking the catheter in place and creating a barrier against bacteria that might try to travel along the tube into your abdomen.
The portion that stays outside your body connects to a transfer set, a short length of tubing that links the catheter to bags of dialysis solution. When you’re not doing an exchange, a disposable cap seals the end to keep it sterile.
Straight Tip vs. Coiled Tip
Tenckhoff catheters come in two main designs: straight tip and coiled tip. The coiled version curls at the end like a pigtail, which was originally thought to reduce the chance of the catheter poking into organs or migrating out of position. In practice, research published in the American Journal of Kidney Diseases found the opposite. In a randomized trial, coiled catheters caused drainage failure or malfunction in 5.8% of patients, compared to just 0.7% with straight catheters. Patients with coiled catheters also reported more pain during fluid infusion. Straight catheters are now generally preferred.
Most catheters are made from silicone, which is well tolerated by the body over long periods and resists infection better than the main alternative, polyurethane. Polyurethane is mechanically stronger and less likely to break, but it carries a higher risk of infection and blood clotting issues. For peritoneal dialysis, silicone is the standard choice.
How the Catheter Works During Dialysis
The catheter itself doesn’t filter anything. It’s simply the pipeline. The real work happens inside your abdominal cavity, where the lining of your belly (the peritoneum) acts as a natural filter. During each “exchange,” dialysis solution flows through the catheter into your abdomen, sits there for several hours while waste products and extra fluid pass from your blood through the peritoneal membrane into the solution, and then drains back out through the same catheter into an empty bag.
The tubing system connects in a Y-shape: one branch leads to a drain bag for used solution, and the other connects to a fresh bag of solution. You drain first, then fill. This process repeats several times a day if you do exchanges by hand (continuous ambulatory peritoneal dialysis), or a machine called a cycler automates the process overnight while you sleep (automated peritoneal dialysis). Either way, the catheter remains in your abdomen at all times between exchanges.
How the Catheter Is Placed
Surgeons place peritoneal dialysis catheters using one of three techniques: laparoscopic surgery (using a small camera and tiny incisions), open surgery (a small cut in the abdomen), or a percutaneous approach (threading the catheter through a needle puncture using imaging guidance). Laparoscopic and open surgical methods are preferred because they allow the surgeon to see exactly where the catheter tip lands and to secure it in the right position. The percutaneous method is less invasive but carries higher risks of the catheter ending up in the wrong spot or injuring the bowel.
The procedure typically uses local or general anesthesia. After placement, the exit site is covered with a sterile gauze bandage, and the catheter is taped down to prevent it from shifting while the cuffs heal into the tissue.
The Break-In Period Before Use
After placement, the catheter ideally needs a two to four week healing period before full-volume dialysis begins. Starting too early increases the risk of fluid leaking around the catheter site. When dialysis can’t wait that long, an urgent-start protocol uses smaller volumes. One common approach starts with just 500 milliliters of solution (about a quarter of a full fill) within the first couple of days, gradually increasing to 750 to 1,000 milliliters over the next five days, and reaching full volumes of 1,000 to 2,000 milliliters within two weeks. Research suggests that waiting at least 48 hours after insertion before starting any dialysis significantly reduces early complications.
Taking Care of the Exit Site
Because the catheter creates a permanent opening in your skin, keeping the exit site clean is one of the most important things you can do to prevent infection. Before touching the area, wash your hands thoroughly and put on clean gloves. Clean around the exit site with antibacterial soap, holding the catheter steady so it doesn’t tug on the skin. Don’t use hydrogen peroxide or alcohol unless specifically instructed, and avoid picking at any crusts or scabs that form around the site.
Bar soap is not recommended because bacteria can grow on its surface. Liquid antibacterial soap kept in its original bottle is the standard. After cleaning, the catheter should be secured to your skin with tape or a belt to prevent it from moving, which can irritate the exit site and increase infection risk.
Common Complications
Peritonitis, an infection of the abdominal lining, is the most serious complication of peritoneal dialysis. It accounted for about 5.9 hospital admissions per 100 patient-years in recent U.S. data, a significant improvement from 15.1 admissions per 100 patient-years a decade earlier. Exit site infections are a major gateway to peritonitis. The most common culprit is Staphylococcus aureus, a bacterium that lives on the skin.
Catheter malfunction is another frequent problem. The tip can migrate out of the pelvis, omental tissue (the fatty apron inside your abdomen) can wrap around the catheter and block the drainage holes, or constipation can press against the catheter and obstruct flow. If you notice that fluid drains slowly or stops draining altogether while filling still works normally, the issue is likely an outflow obstruction. If both directions are blocked, the cause may be a kink in the catheter or a clot inside the tubing. A simple abdominal X-ray can often identify whether the catheter has shifted or whether stool buildup is the problem, which is why staying regular with bowel movements matters more than you might expect.
Roughly 25% of patients who start peritoneal dialysis switch to in-center hemodialysis within two years, most commonly because of peritonitis, catheter problems, or inadequate waste clearance.
Signs of Infection to Watch For
The hallmark of a definitive exit site infection is pus draining from where the catheter exits the skin. Redness alone doesn’t always mean infection, since it can result from tape irritation, cleaning products, or normal healing after placement. But new or worsening redness, especially combined with tenderness, swelling, or crusting, warrants close attention even without pus, as it can signal an early infection.
A tunnel infection, which occurs along the catheter’s path under the skin, shows up as redness, firmness, or tenderness along a line on your abdomen. This sometimes requires an ultrasound to detect fluid collecting around the buried portion of the catheter. Any change from what your exit site normally looks like is worth reporting to your care team promptly, since catching infections early is the best way to protect both the catheter and your peritoneum.