PD (PERITONEAL

DIALYSIS) EXIT SITE CARE

National Kidney and Transplant InstituteInstitute of Advanced Nursing and Allied Health

Professionals (IANAHP)

ObjectivesThe Learner will be able to: Briefly define the meaning of exit site as

well as PD exit site care. Identify the different exit site infections

that can be treated through proper care of the PD exit site.

Identify the materials needed in this procedure and how it is done.

What is an Exit site?

What is an Exit Site? An exit site is the

place where PD catheter comes out of the skin after surgical incision

PD Exit Site Care PD exit care is vital in the prevention of

exit site infections ( ESI ), & the prolongation of PD catheter life.

Organisms at the exit site can migrate

from the skin & descend to the peritoneal cavity via the subcutaneous tunnel leading to peritonitis.

Important Reminders While Performing Exit Site Care Do not forcibly remove crusts and scabs

during cleansing Avoid sudden or extreme traction on the

catheter It is advised to take shower baths

instead of a tub bath Do not use lotions, creams or powders Sutures are never placed at the exit site

The use of dressings (Sterile OS/gauze) may help keep the exit clean, protect it from trauma and help to stabilize the catheter.

Regular use of mupirocin (Bactroban) ointment has shown to decrease the incidence of infection.

DIAGNOSING EXIT SITE INFECTIONS

PD Exit Site Care

Acute Exit Site Infection An acute infection is

characterized by redness, swelling and tenderness. The erythema is more than twice the diameter of the catheter and there is regression of the epithelium in the sinus.

Chronic Exit Site Infection

Granulation tissue is typically present both externally and in the sinus of the exit site in chronic infections.

The exit is sometimes covered by a large, persistent crust or scab.

There is usually no pain, redness or swelling and the skin is often hyper-pigmented.

Equivocal Exit Site Infection  In equivocal ESI, purulent or bloody

drainage is only present in the sinus and cannot be expressed outside, is accompanied by regression of the epithelium and slight exuberant granulation tissue in the sinus.

There might be some mild redness, but there is no pain, swelling or external drainage.

These are often low-grade infections that may improve spontaneously or progress if left untreated.

Tunnel Infections Associated w/ redness,

swelling & tenderness over the tunnel

May be accompanied by intermittent or chronic, purulent or bloody drainage

Ultrasonic evaluation of the tunnel is useful in conforming & assessing the extent of the abscess

MATERIALS FOR EXIT SITE

DRESSING

PD Exit Site Care

Disposable dressing kit

2 pairs of sterile gloves

2 pcs. of 4x4 sterile gauze

10 cc syringe

Disposable face mask

Waterproof transparent dressing film

Povidone iodine solution

Normal saline solution

Mupirocin ointment

PROCEDURE ON EXIT SITE

DRESSING

PD Exit Site Care

Procedures: Wear mask on both

nurse and patient.

Perform hand hygiene.

Place the patient on bed in supine position

Expose the patient’s

PD catheter

Prepare all the materials aseptically.

Remove the old dressing with minimal and gentle movements. This will prevent trauma by mechanical action during handling.

Examine the old dressing and inspect the exit site for signs of infection like redness, crusting, swelling and purulent discharges.

If with purulent discharge, collect specimen for culture and sensitivity

If with crusts, soak gauze w/ hydrogen peroxide w/ 1:10 dilution and wrap around the catheter and leave it for 5 minutes. This will allow softening of the crust.

Never forcibly remove crusts as it may irritate the exit site & possibly cause bleeding

Drape the patient properly and don sterile gloves.

Disinfect catheter and catheter exit site with cotton balls soaked in povidone-iodine solution.

Disinfection should start from the catheter down to the exit site & its immediate surrounding area (inner to outer).

Use single, downward wiping strokes

Repeat this procedure at least 3-4 times

Wipe out excess povidone-iodine on the skin using a 4x4 gauze soaked in sterile plain normal saline solutions.

Gently pat dry exit site & the surrounding area w/ gauze

Apply Mupirocin ointment sparingly around the exit site. The antibiotic serves as prophylactic agent against bacteria

Apply dressing by placing 2 pieces of 4x4 gauze over the catheter exit site

Coil the catheter over the gauze then apply the second 4x4 gauze opverlapping the gauze on the other side of the exit site

After applying the second layer of gauze, place transparent film dressing on top of the dressing

Tape the transfer set to patient’s skin comfortably to minimize excessive tension on the exit site.

Conclusion PD catheter-related exit site infections

remain a significant source of morbidity and technique failure among PD patients.

Prompt diagnosis, early treatment and good exit site care can decrease exit site complications and improve catheter survival.

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