KEY ACTIVITIES
Diagnostic:
- Perform physical exam including palpation over catheter tunnel to assess for induration, inflammation, and pain, and presence of purulent discharge and/or granulation tissue at exit-site
- Palpation of superficial cuff or gentle downward pull of catheter produces purulent discharge from exit sinus
- Ultrasound imaging of subcutaneous track and Dacron cuffs to assess for fluid around catheter and cuffs3
- Refer to surgeon to determine intervention
Therapeutics:
- Surgical interventions may include unroofing of catheter tunnel with shaving of superficial cuff, catheter splicing procedure to new exit-site location with removal of infected segment of catheter with superficial cuff, or simultaneous catheter replacement4, 5
- Infected wounds left open at the time of surgical intervention will require appropriate local care until healed by secondary intention2
- Surgical interventions may be performed without interruption of PD, thereby avoiding temporary HD.4 If simultaneous catheter replacement performed, utilize intermittent regimen of supine, low-volume PD during interval of postoperative recovery; leave peritoneum dry during ambulatory periods2
- Continue appropriate antibiotic coverage
- Monitor wound healing
