PD catheter displacement is a common complication in patients undergoing PD, especially in older patients with end-stage renal failure and is often associated with gastrointestinal dysfunction, such as rapid bowel movements or constipation, accompanied by reduced activity and prolonged bed rest. In addition, older patients often have a relaxed abdominal wall and larger abdominal volume, which further increases the likelihood of catheter displacement [15, 17]. Therefore, how to effectively and quickly resolve the problem of catheter displacement is crucial for successful PD treatment of elderly patients.

At present, the main management strategies for catheter displacement include surgical intervention and traditional conservative repositioning methods [2]. Over the past 20 years, several approaches have been developed for the management of displaced and nonfunctional PD catheters, including Fogarty catheter manipulation [5], double wire guide [12], modified Malecot catheter technique [18], laparoscopy [22, 23], gastroscopic brush correction displacement, microincision techniques [13], and catheter repositioning under local anaesthesia [19]. Although all of these methods have had some success in catheter repositioning, they are invasive procedures that carry risks of infection; additionally, they are expensive and can be more physically and mentally taxing on patients, especially older patients.

Traditional conservative treatments include manual repositioning, sitting and standing with pulsed peritoneal fluid infusion, and having the patient perform calf raises and heel thrusts or walk down stairs after an elevator ride to a high floor, and enema to increase intestinal pressure [21]. These methods are simple and safe, and, to an extent, effective for simple functional catheter displacement; as a result, they are often preferred in clinical practice.

Traditional manual repositioning is usually conducted by one operator. The procedure is as follows: First, 1000 ml of 1.5% peritoneal dialysate is injected into the abdominal cavity. The patient is placed in a supine kneeling position to relax the abdominal muscles. If the catheter tip is in the left lower abdomen, the operator stands on the left side, places both hands on the lower abdomen, aligns with the patient’s breathing, and gradually pushes firmly toward the right lower abdomen during deep breaths. For thicker abdominal walls, the right hand is placed with fingers together at a 45-degree angle on the left abdominal wall, an intermittent shock technique is used and the operator pushes down with the left hand. If the catheter tip is in the right lower abdomen, the direction is reversed. Each session lasts 10 min and is performed 3–5 times daily [20].

Traditional manual repositioning and other conservative strategies are important treatment methods for PD catheter displacement [8]. These have the advantages of high safety, economic benefits, simple operation and little discomfort for patients, and are therefore valuable and popularly used in clinical practice.

Although a previous study reports that the catheter displacement reduction rate for conservative treatment is about 96% (n = 96), the mean age of patients in that study is 40.9 years, and the catheter displacement location is not mentioned [11]. In cases where the catheter is wrapped by the greater omentum and displaced, as well as in elderly patients, who have difficulty walking, surgical intervention is often required to ensure the correct position and function of the catheter [10, 16].

Furthermore, increasing exercise as an auxiliary repositioning measure places higher physical requirements on elderly patients and the infirm, and may be difficult for them to achieve [9]. In addition, although enema can improve abdominal cavity condition in some cases, for patients, especially the elderly and the infirm, it often causes abdominal discomfort, abdominal pain, and other symptoms, and carries a risk of infection [3]. These factors limit the application of traditional manual repositioning in specific groups of patients.

In the case of PD catheter migration, clinical guidelines generally recommend that a conservative repositioning approach be attempted first [4]. While traditional single-operator re-positioning techniques are considered simple and safe, they may lack sufficient force or precision in complex cases, particularly in elderly or frail patients and those with severe catheter displacement. In such situations, the two-person collaborative technique offers a more effective alternative.

The two-person collaborative conservative repositioning method proposed in this study demonstrates clear advantages. By dividing tasks between two operators, this approach enhances precision and efficiency. One operator applies a steady downward force through the palm of the hand, providing the necessary pressure to facilitate catheter repositioning. Simultaneously, the second operator administers saline quickly, leveraging the fluid’s pressure to help guide the catheter smoothly back into the abdominal cavity. This dual-force approach not only improves the stability and success rate of the repositioning but also addresses challenges associated with single-operator techniques, particularly in elderly patients with thickened abdominal walls or increased abdominal volume. Additionally, this method significantly reduces operation time and minimizes patient discomfort.

Another key benefit of this technique is its non-invasive nature. By eliminating the need for surgical equipment, it lowers the risks associated with invasive procedures while also reducing the financial burden on patients. This may make it a practical, cost-effective solution for managing catheter migration, particularly in resource-limited settings or among vulnerable patient populations. To further validate the clinical efficacy of the two-person collaborative conservative repositioning approach, future multicentre, large-scale clinical studies should be conducted to assess its applicability and long-term outcomes across diverse patient populations. Additionally, potential improvements to application of the method in managing complex cases should be explored in order to enhance its overall effectiveness and broaden its clinical utility.