Peritoneal Dialysis Catheter- Post insertion exit site care and Document No.
Guideline and
Procedure
Peritoneal Dialysis Catheter – Acute (Post insertion) exit site
care
Sites where Guideline and Procedure
applies
Target audience:
Description
This Guideline and Procedure applies to:
1. Adults
2. Children up to 16 years
3. Neonates – less than 29 days
All HNE facilities where a patient receives Peritoneal Dialysis
Nephrology clinical staff who provide care to peritoneal
dialysis patients
Yes
Yes
No
Keywords
Exit site, peritoneal dialysis, PD catheters, acute exit site
Replaces Existing Guideline and Procedure Yes
Registration Number(s) and/or name and of HNEH GandP 10_11
Superseded Documents
Related Legislation, Australian Standards, NSW Health Policy Directive, NSQHS Standard/EQuIP
Criterion and/or other, HNE Health Documents, Professional Guidelines, Codes of Practice or Ethics::
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NSW Health Policy Directive 2007_079 Correct patient, Correct procedure, correct site
http://www.health.nsw.gov.au/policies/pd/2007/pdf/PD2007_079.pdf
NSW Health Policy PD 2005_406 Consent to Medical Treatment
http://www.health.nsw.gov.au/policies/PD/2005/pdf/PD2005_406.pdf.
NSW Health Policy Directive PD 2007_036 Infection Control Policy
http://www.health.nsw.gov.au/policies/pd/2007/pdf/PD2007_036.pdf.
Prerequisites (if required)
Registered Nurse or Endorsed Enrolled Nurse who have been deemed
competent in the performance of peritoneal dialysis
Guideline and Procedure Note This document reflects what is currently regarded as safe and appropriate
practice. The guideline section does not replace the need for the
application of clinical judgment in respect to each individual patient but the
procedure/s require mandatory compliance. If staff believe that the
procedure/s should not apply in a particular clinical situation they must
seek advice from their unit manager/delegate and document the variance
in the patient’s health record.
If this document needs to be utilised in a Non Clinical Area please liaise
with the Infection control Service to ensure the appropriateness of the
information contained within the Guideline and Procedure.
Position responsible for the
HNELHD Renal Clinical Stream Leadership Group
Guideline and Procedure and
authorised by
Contact Person
Tina Straker, Kelly Adams
Contact Details
02 67769912, 02 49048800
Date authorised
This Guideline and
No
Procedure contains advice
on therapeutics
Date of Issue
Review due date
TRIM Number
Version Number
Month and Year
Note: Over time links in this document may cease working. Where this occurs please source the document in
the PPG Directory at: http://ppg.hne.health.nsw.gov.au/
OUTCOMES
1
Minimise the incident of infection post peritoneal dialysis catheter insertion
2
Minimise the trauma to the exit site from unnecessary movement of the catheter
ABBREVIATIONS & GLOSSARY
Exit site
The site at which the peritoneal catheter exits the abdomen
Tunnel
The subcutaneous track or pathway of the catheter from the exit site to
where the catheter enters the peritoneum
Preamble
“Optimal postoperative care promotes healing of the exit-site wound and the catheter tract” (Mujais
et al. 2006:10). This should include immobilising the catheter to minimise trauma at the exit site
and minimise exposure to bacteria, particularly in the initial 2 week healing period (Piraino et al:
2005:109).
Post insertion – the first 2 weeks:
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Post insertion, dressing stays intact for the first 7 days.
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Inspect and change dressing weekly (DAY 7 & DAY 14) or more frequently in the presence of
delayed healing or infection. Polyurethane dressing must be changed after 1 week if it has not
required changing previously.
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Dressings to remain clean, dry and intact.
Reinforce dressing with combine once if
breakthrough evident. Change dressing if it is wet or grossly contaminated.
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In the initial 2 week period, dressings must be conducted aseptically i.e. using mask and
sterile gloves (Mujais et al. 2006:10)
Day 14- the first 3 months:

In the initial post insertion phase, a pink to red exit site is normal.

Localised redness is an inflammatory reaction to the catheter; this develops around Day 3
post-operatively and usually resolves within 6 to 8 weeks.

Scab formation and crusting are also fairly common in the new exit site. It is important to
record and monitor the exit site condition, to distinguish this initial inflammatory reaction
from infection.

Continue daily dressing with antiseptic solution- 2% Chlorhexidine gluconate or 10%
providine-iodine
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PROCEDURE
This procedure requires mandatory compliance.
Patient Preparation
It is mandatory to ensure that the patient has received appropriate information to provide informed
consent and, that patient identification, correct procedure and correct site process is completed
prior to any procedure.
Staff Preparation
It is mandatory for staff to follow relevant: “Five moments of hand hygiene”, infection control,
moving safely/safe manual handling, and documentation practices.
Equipment Requirements (Day 1-first 2 weeks)
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1 x dressing pack, including gauze
Paper tape, woven tape or waterproof dressing (eg: Hypafix, Mefix, Opsite, Mepore)
1 x packet of polyurethane foam dressing (e.g. Allevyn, Lyofoam)
Sterile gloves, disposable face mask
1 pair of unsterile gloves
1 x pair sterile scissors
1 x 30ml 0.9% Sodium Chloride
Sterile combine pad
Personal protective equipment
Patients’ Medical Records
Alcohol hand gel
Procedure Steps (Day1- first 2 weeks)
1. Gel hands, don mask and clean table
2. Open dressing pack
3. Open other sterile equipment onto dressing pack using non-touch technique
4. Gel hands
5. Don non sterile gloves and carefully remove old dressing from exit site. DO NOT pull catheter
6. Inspect wound for redness and discharge. Inform the medical officer if present
Note: If redness, bleeding or discharge is present during exit site inspection - medical
officer intervention should be sought as a swab of the exit site may need to be taken and
topical or oral antibiotic treatment commenced.
7. Remove non sterile gloves
8. Perform 3 minute scrub
9. DON sterile gloves
10. Using sterile scissors cut a slit in polyurethane foam dressing from edge to middle
11. Clean around catheter with saline solution and then dry with sterile gauze
12. Place sterile foam dressing around catheter exit site as specified by the manufacturer (i.e.
which side of foam dressing toward skin)
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13. Secure catheter with anchor tape 4cm away from exit site ensuring catheter remains in correct
alignment without any tension on exit site
14. Place combine pad over the foam dressing and secure with either woven tape or waterproof
dressing
15. Record dressing change and exit site classification in patient’s medical records.
Pic 1: PD exit site at 14 days post insertion – note correct position of anchor tape and catheter alignment
Equipment Requirements (Day 14-first 3months)
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Gauze squares x 1
Tape (NOTE: use same type of tape patient uses at home to avoid possible irritation)
Antiseptic solution, either 2 % Chlorhexidine Gluconate swabs or Povidone-Iodine swabs (if
Chlorhexidine contra indicated)
Cream or ointment if ordered for exit site e.g. Mupirocin ointment, medicated honey
Non sterile gloves
1 x dressing pack, including gauze
Personal protective equipment
Patients’ Medical Records
Alcohol hand gel
Procedure Steps for day 14-first 3 months
1. Wash/gel hands
2. Ensure catheter is securely taped to the body (anchor tape 3-4cm from the exit site) and
catheter is in correct alignment without any tension on exit site
3. Remove old dressing, leaving anchor tape in place
4. Gel hands, allow to dry (Don gloves if any crusting or exudate is present)
5. Inspect exit site – note any tenderness, inflammation or discharge
6. Wash/gel hands
7. Don non sterile gloves
8. Remove old anchor tape and ensure catheter is not pulled or twisted whilst attending exit site
dressing
9. Swab around exit site with 2% Chlorhexidine Gluconate or Povidone-Iodine swabs, starting at
one fixed point and coming around catheter to meet that point. Allow to dry.
10. If applying any ointment to exit site, apply ointment now around exit site using a gauze square
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11. If patient uses a pillow dressing under catheter to retain catheter’s natural position, fold one
piece of dry gauze in half and carefully place under catheter
12. Replace anchor tape 4 cm away from exit site ensuring catheter is in correct alignment without
any tension on exit site
13. Apply clean gauze dressing, over exit site and tape all four edges of the gauze (like a window
frame)
14. Secure catheter to abdomen where comfortable
APPENDICES
Five Moments of Hand Hygiene
REFERENCES
Hand Hygiene Australia 2008: Five Moments for Hand Hygiene
Mujais, S., Crabtree, J.H., Firanek, C.A., Piraino, B., Abu-Alfa, A.K. (2006). Access care and
complications management, Care of the adult patient on peritoneal dialysis. Baxter
Piraino, B., Bailie, G.R., Bernardini, J., Boeschoten, E., Gupta, A., Holmes, C., Kuijper, E.J., Li,
P.K., Lye, W., Mujais, S., Paterson, D.L., Fontan, M.P., Ramos, A., Schaefer, F, Uttley, L. ISPD
guidelines/recommendations, Peritoneal dialysis-related infections recommendations: 2005
update. 2005. Peritoneal Dialysis International, Vol 25, pp. 107-131
FEEDBACK
Any feedback on this document should be sent to the Contact Officer listed on the front page.
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