EXIT SITE CARE Flashcards
For optimal hygiene what is good exit site care for the PD catheter?
Patients should shower and perform site care and tunnel inspection on a daily basis.
Peritoneal dialysis catheter exit site care differs between the period just after catheter insertion and the long term, when the incision and catheter exit site have healed.
The goal of site care and dressing changes right after catheter implantation is to keep the exit site free of microorganisms for as long as possible while it is healing.
How is exit site dressing changes performed on a new PD catheter?
Complete separately from the incision care. Use “sterile technique” using sterile supplies.
During initial care it is important to use a fairly mild cleaning agent that does not irritate the wound and to use a sterile solution to rinse the exit site.
When performing site care to a new PD catheter, sterile gloves and a sterile 4x4 gauze should be used and the exit site should be cleansed using Bulls-Eye Technique working outward and away from the insertion site.
Is it acceptable for the PD catheter and exit site to get wet?
Not always. It is recommended that the patient not swim in a lake, take a tub bath or use a hot tub.
Swimming in the ocean or their own chlorinated swimming pool is allowed after the exit site is completely healed.
(Patients should be reminded to perform exit site care immediately after swimming in the ocean or their chlorinated swimming pool to prevent infection).
How should the exit site be cared for once the site is healed?
Sterile supplies are no longer necessary for chronic exit site care; a clean washcloth or towel should be used.
Tap water can be used to rinse the exit site as long as it is chlorinated.
If well water is used, it should be checked for microorganisms.
It is also important for the exit site to be dried well after it is cleaned since germs can multiply faster in a moist environment.
It is extremely important to keep the exit site clean and to prevent trauma.
How should the dressing be applied to an exit site?
A dry dressing should be applied to the catheter site after site care has been performed, and it should be taped down securely, but not occlusively.
Why is an antibacterial ointment often recommended to be applied to an exit site?
Bactroban ointment (mupuricin) or triple antibiotic ointment may be applied to the exit site after cleaning to prevent infections per MD order.
Bactroban has been shown to be effective in preventing staph aureus infections in patients who carry staph on their skin or in their nose.
How can infection be prevented while drawing dialysate samples?
Soak the medication port with an approved disinfectant such as Betadine or Alcavis solution for 3-5 minutes prior to drawing the sample.
Can disinfectants and cleansing agents damage a PD catheter?
Yes.
Note that some disinfectants or cleansing agents can damage the PD catheter.
For instance, alcohol and Bactroban can cause deterioration of polyurethane catheters.
Iodine or Betadine can cause damage to Silicone catheters.
Is it Ok to cut off exit site dressing with a scissors?
No!
Do not cut off dressings or remove tape with a scissors.
Scissors should never be used when performing a dressing change.
