PD (Peritoneal Dialysis) Exit Site Care
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PD (PERITONEAL
DIALYSIS) EXIT SITE CARE
National Kidney and Transplant InstituteInstitute of Advanced Nursing and Allied Health
Professionals (IANAHP)
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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.
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What is an Exit site?
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What is an Exit Site? An exit site is the
place where PD catheter comes out of the skin after surgical incision
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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.
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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
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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.
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DIAGNOSING EXIT SITE INFECTIONS
PD Exit Site Care
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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.
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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.
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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.
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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.
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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
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MATERIALS FOR EXIT SITE
DRESSING
PD Exit Site Care
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Disposable dressing kit
2 pairs of sterile gloves
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2 pcs. of 4x4 sterile gauze
10 cc syringe
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Disposable face mask
Waterproof transparent dressing film
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Povidone iodine solution
Normal saline solution
Mupirocin ointment
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PROCEDURE ON EXIT SITE
DRESSING
PD Exit Site Care
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Procedures: Wear mask on both
nurse and patient.
Perform hand hygiene.
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Place the patient on bed in supine position
Expose the patient’s
PD catheter
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Prepare all the materials aseptically.
Remove the old dressing with minimal and gentle movements. This will prevent trauma by mechanical action during handling.
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Examine the old dressing and inspect the exit site for signs of infection like redness, crusting, swelling and purulent discharges.
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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
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Drape the patient properly and don sterile gloves.
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Disinfect catheter and catheter exit site with cotton balls soaked in povidone-iodine solution.
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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
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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
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Apply Mupirocin ointment sparingly around the exit site. The antibiotic serves as prophylactic agent against bacteria
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Apply dressing by placing 2 pieces of 4x4 gauze over the catheter exit site
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Coil the catheter over the gauze then apply the second 4x4 gauze opverlapping the gauze on the other side of the exit site
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After applying the second layer of gauze, place transparent film dressing on top of the dressing
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Tape the transfer set to patient’s skin comfortably to minimize excessive tension on the exit site.
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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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