Guideline 1: Access team

Guideline 2: Timing 2.1 We suggest that, whenever possible, catheter insertion should be performed at least 2 weeks before starting PD. Small dialysate volumes in the supine position can be used if dialysis is required earlier (2B).

Guideline 3: Implantation protocol3.1 We recommend that renal units should have clear protocols for perioperative catheter care, including the use of antibiotic prophylaxis (1A).

Guideline 4: Implantation technique 4.1 We recommend that local expertise at individual centers should govern the choice of method of PD catheter insertion (1B).4.2 We recommend that each PD unit should have

the ability to manipulate or reimplant PD catheters when necessary (1B). 4.3 We recommend that urgent removal of PD catheters should be available where necessary (1A).4.4 We recommend that timely surgical support should be available for the review of PD patients (1A).

Guideline 5: Facilities 5.1 We recommend that a dedicated area should be used for catheter insertion with appropriate staffing, suction, oxygen, and patient monitoring facilities (1A). 5.2 We suggest that no particular catheter type is proven to be better than another (2C).5.3 We suggest that a catheter of a suitable size should be used (2C).5.4 We suggest that PD catheters should be inserted as day case procedures as long as this does not compromise the quality of care (2C).

Guideline 6: Training 6.1 We recommend that PD catheter insertion training should be available to all trainees with an interest (1C).6.2 We recommend that PD catheter insertion should not be delegated to inexperienced unsupervised operators (1A).

Guideline 7: Audit7.1 We recommend that there should be regular audit at not less than 12-month intervals of the outcome of catheter insertion as part of multidisciplinary meetings of the PD team and the access operators (1B).