Early Exit Site Care

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The usual practice after implantation is to cover the exit site with several layers of sterile gauze. Transparent, occlusive dressings are not be used alone because drainage tends to pool at the exit site and in the sinus¹. Gauze dressings are generally preferred because they wick the drainage away from the exit. The surgical dressing is generally not changed for several days unless there is obvious bleeding or signs of infection.

The standard practice for dressing changes, which should be performed by experienced PD staff, are usually avoided in the immediate post implantation period in order to minimize contamination and local trauma to the exit site. Dressings are changed once per week. Once the exit is colonized with bacteria, usually by the 2nd or 3rd week, more frequent dressing changes are indicated. Patients are instructed to avoid submerging the exit site during healing to avoid colonization with water-borne organisms. There is no clear consensus as to when patients may begin to shower or change to chronic exit site care. If you use Twardowski's exit site evaluation and classification system, when the exit site can be classified as good or equivocal then showering and chronic care are recommended². One center found that the use of a shower or bath and covering or uncovering the exit site did not influence the incidence of ESI³.

Povidone iodine and hydrogen peroxide are not recommended for use routinely. If required, keep these solutions out of the exit sinus. Other cleansing agents include normal saline or mild soap. As much as possible, the catheter is to be immobilized with a dressing or tape; or with a specially designed device to prevent pressure injury around the exit. Sutures are never placed at the exit site.

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References:

1. Gokal R, Alexander S, Ash S, Chen TW, Danielson A, Holmes C, Joffe P, Moncrief J, Nichols K, Piraino B, Prowant B, Slingeneyer A, Stegmayr B, Twardowski Z, Vas, S. Peritoneal catheters and exit-site practices: Toward optimum peritoneal access. Perit Dial Int 18:11-33,1998
2. Twardowski ZJ, Prowant B. Classification of normal and diseased exit sites. Perit Dial Int 16 (Supp 3):S32-S50, 1996
3. Pandya BK, Marshall L, Ahmad R. Postoperative exit-site infection and factors affecting it. Perit Dial Int 21:418-419, 2001