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Peritoneal dialysis catheter management and exit‐site care: an Australian survey of current practices
Author(s) -
IBELS Lloyd S,
VENUS Pamela D,
WATTS Robin L,
WILSONSTEPHENS Vanessa G
Publication year - 1997
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/j.1440-1797.1997.tb00206.x
Subject(s) - medicine , exit site , catheter , peritoneal dialysis , stylet , surgery
Summary: In view of the apparently high prevalence of patient dropout from peritoneal dialysis due to peritoneal catheter related issues, a national survey was undertaken to examine current unit practices and to identify areas in which changes in procedure might lead to improved results. Problems related to the catheter itself accounted for 28% of the principal indications for removal of the peritoneal catheter. A number of practices were identified as potentially suboptimal, which, if changed, might lead to improved outcomes. In determining placement, the exit‐site was marked while the patient was seated, and patient preference taken into account in less than two thirds of the units. Skin preparation, including shaving of the abdominal wall prior to catheter insertion, and administration of prophylactic antibiotics were not universally practised. Dedicated surgeons performing the procedure were available in less than half of the units. Techniques to expel air from the dacron cuffs at the time of placement were used in only one‐third of the units. Laparoscopy was used in only a small percentage of units. Other practices identified as potential means of improving outcomes were use of a stylet to manoeuvre the catheter into place and a trocar to create the exit‐site, facing the exit‐site in a downward position, creating the exit‐site the same diameter as the catheter, not using sutures at the exit‐site, delaying the use of the catheter for dialysis, delaying showering early after implantation and not using strong oxidants such as povidone iodine. It is hoped that review of some current procedures in light of these results might reduce the high prevalence of loss of peritoneal catheters.