PD catheter insertion(Missouri type), Step by Step

1. The patient is draped and the abdomen is exposed
2. Draw catheter position and entry site
3. Subumbilical incision, introduction of trocar and establishing pneumoperitoneum
4. Intra abdominal laparoscopic inspection
5. Paramedian incision and opening anterior rectus sheath
6. Exposing posterior rectus sheath
7. Place purse string suture in posterior rectus sheath
8. Insert stilette in catheter and avoid rotation
9. Opening peritoneum
10. Leave about 1cm of catheter beyond tip of stilette to avoid bowel damage during introduction
11. Insert catheter and check position
12. Position catheter in Douglas’s pouch
13. Partially retract stilette and enhance catheter position
14. Introduce bead into peritoneal cavity (laparoscopic guidance)
15. Place flange flat on posterior rectus sheath
16. Remove stilette
17. Tie purse string securely between bead and flange
18. Anchor flange with 4 sutures
19. Create subcutaneous pocket for bent portion of catheter
20. Tunnel catheter to exit site
21. Suture anterior rectus fascia and avoid constricting catheter
22. Attach connector and infuse sterile saline
23. Final laparoscopic check of catheter position
24. Release pneumoperitoneum and close subumbilical fascia
25. Skin closure and check catheter function