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An exit site infection can be limited to the exit site or may extend into the subcutaneous tunnel. Infections can be acute or chronic (acute infections last for less than 4 weeks, while chronic are longer in duration).
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. An acute infection is often painful and a scab might be present, but crusting alone does not mean infection. Purulent drainage is always cultured. However, positive cultures of normal appearing exit sites indicate colonization, and not infection.
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 infections. 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 not pain, swelling or external drainage. These are often low-grade infections that may improve spontaneously or progress if left untreated.
Tunnel infections. Tunnel infections are associated with redness, swelling and tenderness over the tunnel and may be accompanied by intermittent or chronic, purulent or bloody drainage, which discharges spontaneously or after pressure on the cuff. These infections are often occult and are usually located between the internal and external cuffs. Ultrasonic evaluation of the tunnel is useful in confirming and assessing the extent of the peri-catheter abscess1. Most, but not all, tunnel infections occur in conjunction with exit site infections. The presence of a tunnel infection increases the risk for peritonitis.
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Reference:
- Diaz-Buxo JA, Black EB, Tyroler J. Ultrasonography in the diagnosis of peritoneal dialysis catheter tunnel abscess. Perit Dial Int 8:218-219, 1988