Peritoneal Catheters and Exit-Site Practices toward Optimum Peritoneal Access: 1998 Update

Gokal, Ram; Alexander, Steven R.; Ash, Stephen R.; Chen, Tzen W.; Danielson, Anders; Holmes, C. J.; Joffe, Preben; Moncrief, Jack W.; Nichols, Kirt; Piraino, Beth; Prowant, Barbara F.; Slingeneyer, A; Stegmayr, Bernd; Twardowski, Zbylut J.; Vas, Stephen I.

doi:10.1177/089686089801800102

Cited by 240 publications

(211 citation statements)

References 68 publications

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“…Lifestyle: Rules of conduct to maintain and preserve the exit site condition (Gokal et al 1998 Infected exit site: Exit site with pus or bloody secretion, possibly with redness, sensitive or painful, hypergranulation, tumour and crusts (Twardowski & Prowant 1997;Piraino et al 2005).…”

Section: Methodsmentioning

confidence: 99%

Exit site care in the Netherlands: the use of guidelines in practice

Hoekstra

Vries-Hoogsteen

Winkels³

et al. 2017

Journal of Renal Care

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Section: Methodsmentioning

confidence: 99%

Exit site care in the Netherlands: the use of guidelines in practice

Hoekstra

Vries-Hoogsteen

Winkels³

et al. 2017

Journal of Renal Care

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“…13 TI was defined as erythema, oedema and/or tenderness over the subcutaneous pathway and may be characterized by intermittent or chronic, purulent, bloody, or gooey drainage that discharges spontaneously or after pressure on the cuff. 13 The scoring of the exit site was not performed in this study. 14,15 Recurrence of an ESI was defined as an episode that occurs within 4 weeks after completing therapy for a previous episode but with a different organism.…”

Section: Methodsmentioning

confidence: 99%

“…Exit site infections were treated with antibiotics according to ISPD guidelines, starting empirical Gram positive and Gram negative cover antibiotics before swabs results guided ongoing therapy. 13,14 In the case of slow response or MRSA, rifampicin 600 mg orally daily was added. Oral ciprofloxacin was used for Gram negative organisms.…”

Section: Methodsmentioning

confidence: 99%

Catheter revision for the treatment of intractable exit site infection/tunnel infection in peritoneal dialysis patients: A single centre experience

Cho

Park

et al. 2012

Nephrology

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: Aim: Catheter‐related infection is a major cause of catheter loss in peritoneal dialysis (PD). We evaluated the effect of catheter revision on the treatment of intractable exit site infection (ESI)/tunnel infection (TI) in PD patients who required catheter removal. Methods: We reviewed the medical records of 764 continuous ambulatory peritoneal dialysis (CAPD) patients from May 1995 to April 2011 at our hospital. One hundred and twenty six patients had more than one occurrence of ESI. Catheter revision was performed to treat intractable ESI/TI. Incidence of ESI, causative organisms and the outcomes of catheter revision were analyzed. Results: The total PD duration of all patients was 32 581 months. Three hundred and twelve ESI episodes occurred in 126 patients and the incidence of ESI was 1/104 patient‐months (0.12/patient‐year). The most common causative organism was methicillin‐sensitive Staphylococcus aureus (MSSA) (98 episodes), followed by Pseudomonas aeruginosa (63 episodes) and methicillin‐resistant S. aureus (MRSA) (28 episodes). Among these, catheter revision was required due to intractable ESI/TI in 36 patients. The most common causative organism was MSSA (14 episodes) followed by P. aeruginosa (10 episodes) and MRSA (six episodes) in catheter revision cases. The outcomes of catheter revision were as follows: ESI relapsed in 11 patients (30.6%) after catheter revision. Among them, five patients were treated with antibiotic treatment, two patients required secondary catheter revision, four patients required catheter removal due to ESI/TI accompanying peritonitis. The catheter survival rate after catheter revision was 89.7% in one year. There were no statistical differences in the rates of ESI relapse after catheter revision between ESI caused by P. aeruginosa (5/10, 50%) and ESI caused by S. aureus (6/21, 28.6%). Conclusion: Catheter revision may be an alternative treatment option to treat intractable ESI/TI before catheter removal is considered in PD patients.

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“…The erythema needs to be more than twice the catheter diameter; there is regression of the epithelium in the sinus. 25 Chronic Exit-Site Infection Symptoms of chronic infection are similar to those of acute infections; however, exuberant granulation tissue is more common both externally and in the sinus. Granulation tissue at the external exit is sometimes covered by a large stubborn crust or scab.…”

Section: Types Of Outcome Measuresmentioning

confidence: 99%

“…Pain, erythema, and swelling are frequently absent in chronic infection. 25 Tunnel Infection This was defined as erythema, oedema and/or tenderness over the subcutaneous pathway, and may be characterised by intermittent or chronic, purulent, bloody or viscous drainage that discharges spontaneously or after pressure on the cuff. 25 Peritonitis This was defined as two positive peritoneal fluid cultures in an asymptomatic person or one positive peritoneal fluid culture in a person with symptoms of peritonitis (such as abdominal pain, fever and cloudy peritoneal fluid) (Review Panel Consensus).…”

Section: Types Of Outcome Measuresmentioning

confidence: 99%

Clinical effectiveness of different approaches to peritoneal dialysis catheter exit-site care

Lockwood

Hodgkinson

Page

2003

JBI Database of Systematic Reviews and Implementation Reports

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Executive summaryObjective The objective of this review was to appraise and synthesise the best available evidence on the clinical effectiveness of peritoneal dialysis catheter exit-site care. Inclusion criteriaThis review considered all randomised controlled trials that evaluated the effectiveness of peritoneal exit-site care. In the absence of randomised controlled trials, other controlled research designs such as non-randomised controlled trials were considered for inclusion in a narrative summary to enable the identification of current approaches and possible future strategies. Participants of interest were adults with chronic renal failure on maintenance peritoneal dialysis. Interventions of interest were those used to manage peritoneal catheter exit sites, and included types of dressings, frequency of dressings, types of skin care, and use of topical antiseptic or antimicrobial agents. Search strategyThe search sought to find both published and unpublished studies.An initial limited search of MEDLINE and CINAHL databases was undertaken to identify key words contained in the title or abstract, and index terms used to describe relevant articles. A second extensive search was undertaken using all identified key words and index terms. The third step was a search of the reference lists and bibliographies of all relevant articles.Methodological quality All identified studies that met the inclusion criteria were assessed for methodological validity by two reviewers prior to inclusion in the review. Critical appraisal of studies focused on identifying bias in selection, performance, attrition and detection. ResultsThis review found few studies of sufficient quality to meet the inclusion criteria.The included studies often utilised historical control groups, potentially confounding measurement of their outcomes. The outcome measures varied considerably, thus meta-analysis was not possible. ConclusionsThis review suggests topical mupirocin may reduce the risk of exit-site infection; however, the clinical effectiveness of any one antibiotic, antiseptic or dressing 168 C Lockwood et al.

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Peritoneal Catheters and Exit-Site Practices toward Optimum Peritoneal Access: 1998 Update

Cited by 240 publications

References 68 publications

Exit site care in the Netherlands: the use of guidelines in practice

Exit site care in the Netherlands: the use of guidelines in practice

Catheter revision for the treatment of intractable exit site infection/tunnel infection in peritoneal dialysis patients: A single centre experience

Clinical effectiveness of different approaches to peritoneal dialysis catheter exit-site care

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