KEY ACTIVITIES
- Inspect and change dressing weekly or more frequently in the presence of:
-
- Delayed healing
- Infection1
- Gross contamination
- Wetness
- Maintain clean, dry, intact dressings1
- Utilize aseptic technique using mask and gloves1
- Exit-site care:
-
- Minimize manipulation of catheter
- Use aseptic technique, including masking and wearing sterile gloves for postoperative dressing changes until healed13
- Inspect and classify exit-site1, 14
- Palpate tunnel
- Clean with nonirritating solution (i.e., nonionic surfactant, normal saline, or chlorhexidine)1, 11
- Protect sinus track and wound from povidone iodine and hydrogen peroxide1, 14
- Tape dressing securely1
- Immobilize catheter1
- Perform catheter irrigation with 500–1000ml saline or dialysate within 24 hours following catheter insertion to wash out blood and fibrin that can plug the catheter and/or form obstructing adhesions.
- If the catheter is not used for a time, it is advisable to repeat irrigation periodically, such as during weekly dressing changes, to assure patency and function by the time the patient is ready to start dialysis training. Heparin, 1000 units/L may be added to irrigant to help prevent blood clots and fibrin plugs.
- Catheters that are exteriorized secondarily (Moncrief technique) can be used immediately for full-volume peritoneal dialysis.7 Exit-site management for secondarily exteriorized catheters is the same as described for primary exteriorization.
