KEY ACTIVITIES
Initiate the following:
- Culture and Gram stain of purulent exudate and/or drainage
-
- Experienced PD nurse may express fluid by pressing on the superficial cuff or with a gentle downward pull of catheter
- Initiate empiric antibiotic therapy as indicated by clinical appearance5
-
- Empiric therapy should include Staphylococcus aureus coverage5
- In patients with history of pseudomonas ESI, empiric therapy should include targeted antibiotic therapy5
- In the absence of purulence, tenderness, or swelling, consider intensified local care (e.g., hypertonic saline soaks)2
- Monitor and document condition of exit-site, sinus, and tunnel5
- Exit-site infection due to S. aureus and pseudomonas are often associated with tunnel involvement5
- If tunnel infection suspected, ultrasound of subcutaneous pathway may be helpful5
- Increase intensity of exit-site care and dressing changes5
- Retrain patient on appropriate exit-site care6
- Close follow-up with patient to evaluate response to treatment plan5
