Daily self‐care practices influence exit‐site condition in patients having peritoneal dialysis: A multicenter cross‐sectional survey

Abstract

Aims To investigate practice patterns in exit‐site care and identify the risk factors for exit‐site infection. Design A quantitative cross‐sectional design. Methods Data were collected in 12 peritoneal dialysis (PD) centres in 2018. Daily exit‐site care practice patterns and exit‐site status of patients receiving PD were assessed through interviews and questionnaires. Results/findings Most of the 1,204 patients adhered with the protocols about main aspects of exit‐site care, such as cleansing agents selection, frequency of cleansing, catheter fixation, and following the catheter protective measures. However, their adherence levels on hand hygiene, mask wearing, observing exit site, examining secretion, and communicating with PD staff were rather low. Eighty‐four patients' exit sites were evaluated as problematic exit site (PES). And 186 patients had catheter‐related infection (CRI) history. After multivariable logistic regression analysis, diabetes (OR = 1.631), traction bleeding history (OR = 2.697), antibiotic agents use (OR = 2.460), compliance on mask wearing (OR = 0.794), and observing exit site (OR = 0.806) were influencing factors of CRI history. Traction bleeding history (OR = 2.436), CRI history (OR = 10.280), and effective communication (OR = 0.808) with PD staff were influencing factors for PES. Conclusions The adherence levels on different aspects of exit‐site care were varied in patients having PD. Their self‐care behaviours did correlate with the exit‐site status. Impact The adherence level of patients’ exit‐site care practice needs attention of medical staff. Further studies about the optimal procedure in exit‐site care were warranted.

Negative-pressure wound therapy is effective for peritoneal dialysis catheter exit-site management in the early postoperative period

“…Although our center ensured that patients underwent a three-week PD training conducted by nursing staff with the appropriate qualifications and experience during their hospitalization, daily PD catheter exit-site care tends to become more personalized as the PD duration increases. Ding et al reported that the level of adherence to different aspects of exit-site care varies among PD patients 21 . The study found that patient adherence to proper hand hygiene, mask wearing, exit-site observation, secretion examination, and effective communication with PD staff influenced CRI history and exit-site issues.…”

Negative-Pressure Wound Therapy is Effective for Peritoneal Dialysis Catheter Exit-Site Management in The Early Postoperative Period

“…reported that the level of adherence to different aspects of exit-site care varies between PD patients 24 .…”

ISPD Catheter-related Infection Recommendations: 2023 Update

“…The practice of fixing the catheter by waist belt, protective bag or securing the transfer/extension set to the abdomen by adhesive tape is supported by several observational studies on risk factors of exit site infection. A history of catheter pulling injury or traction bleeding, based on multivariate regression analysis, was associated with increased exit site infections in two studies (hazard ratio 1.78, 95% CI 1.02–3.11 19 and 2.44, 95% CI 1.47–4.04 78 ). We believe this recommendation of fixing the PD catheter also aligns with the ISPD and the Global Renal Exercise Network practice recommendations 79 to avoid repetitive rubbing of the catheter site during sports activity, and the use of a belt during sports to provide protection.…”

“…Contrary to the previous recommendation to protect the exit site with dressing material such as sterile gauze coverage, continuing this practice beyond the immediate post-operative period is not supported by one RCT 18 and two observational studies. 78,81 A single-centre, open-label RCT involving 97 participants in Malaysia showed that simple washing and cleansing of the exit site followed by topical mupirocin with or without a dressing cover resulted in similar incidences of catheter-related infection. 18 The exceptionally low exit site infection rate in this study, at 0.05–0.11 episodes per year, could have limited the external validity of their findings.…”