National Kidney and Transplant Institute

Institute of Advanced Nursing and Allied Health

Professionals (IANAHP)

PD
(PERITONEAL
DIALYSIS) EXIT
SITE CARE

Objectives
The Learner will be able to:

Briefly define the meaning of exit site as

well as PD exit site care.
Identify the different exit site infections
that can be treated through proper care
of the PD exit site.
Identify the materials needed in this
procedure and how it is done.

What is an Exit site?

What is an Exit Site?

An exit site is the

place where PD
catheter comes out
of the skin after
surgical incision

PD Exit Site Care

PD exit care is vital in the prevention of

exit site infections ( ESI ), & the
prolongation of PD catheter life.

Organisms at the exit site can migrate

from the skin & descend to the
peritoneal cavity via the subcutaneous
tunnel leading to peritonitis.

Important Reminders While

Performing Exit Site Care

Do not forcibly remove crusts and scabs

during cleansing
Avoid sudden or extreme traction on the
catheter
It is advised to take shower baths
instead of a tub bath
Do not use lotions, creams or powders
Sutures are never placed at the exit site

The use of dressings (Sterile OS/gauze)

may help keep the exit clean, protect it
from trauma and help to stabilize the
catheter.
Regular use of mupirocin (Bactroban)
ointment has shown to decrease the
incidence of infection.

PD Exit Site Care

DIAGNOSING EXIT
SITE INFECTIONS

Acute Exit Site Infection

An acute infection is
characterized by
redness, swelling
and tenderness. The
erythema is more
than twice the
diameter of the
catheter and there is
regression of the
epithelium in the
sinus.

Chronic Exit Site

Infection

Granulation tissue is
typically present both
externally and in the
sinus of the exit site in
chronic infections.
The exit is sometimes
covered by a large,
persistent crust or scab.
There is usually no
pain, redness or
swelling and the skin is
often hyper-pigmented.

Equivocal Exit Site

Infection

In equivocal ESI, purulent or bloody

drainage is only present in the sinus and
cannot be expressed outside, is
accompanied by regression of the
epithelium and slight exuberant
granulation tissue in the sinus.

There might be
some mild redness,
but there is no pain,
swelling or external
drainage.
These are often lowgrade infections that
may improve
spontaneously or
progress if left
untreated.

Tunnel Infections

Associated w/ redness,
swelling & tenderness
over the tunnel
May be accompanied
by intermittent or
chronic, purulent or
bloody drainage
Ultrasonic evaluation of
the tunnel is useful in
conforming &
assessing the extent of
the abscess

PD Exit Site Care

MATERIALS FOR
EXIT SITE
DRESSING

Disposable dressing kit

2 pairs of sterile gloves

2 pcs. of 4x4 sterile gauze

10 cc syringe

Disposable face mask

Waterproof transparent dressing film

Normal saline solution

Povidone iodine
solution

Mupirocin ointment

PD Exit Site Care

PROCEDURE ON
EXIT SITE
DRESSING

Procedures:

Wear mask on both

nurse and patient.

Perform hand
hygiene.

Place the patient on

bed in supine
position

Expose the patients

PD catheter

Prepare all the materials aseptically.

Remove the old dressing with minimal

and gentle movements. This will prevent
trauma by mechanical action during
handling.

Examine the old

dressing and inspect
the exit site for signs
of infection like
redness, crusting,
swelling and
purulent discharges.

If with purulent discharge,

collect specimen for
culture and sensitivity
If with crusts, soak gauze
w/ hydrogen peroxide w/
1:10 dilution and wrap
around the catheter and
leave it for 5 minutes. This
will allow softening of the
crust.
Never forcibly remove
crusts as it may irritate
the exit site & possibly
cause bleeding

Drape the patient

properly and don
sterile gloves.

Disinfect catheter
and catheter exit site
with cotton balls
soaked in povidoneiodine solution.

Disinfection should
start from the catheter
down to the exit site &
its immediate
surrounding area
(inner to outer).
Use single,
downward wiping
strokes
Repeat this procedure
at least 3-4 times

Wipe out excess

povidone-iodine on
the skin using a 4x4
gauze soaked in
sterile plain normal
saline solutions.
Gently pat dry exit
site & the
surrounding area w/
gauze

Apply Mupirocin
ointment sparingly
around the exit site.
The antibiotic serves
as prophylactic
agent against
bacteria

Apply dressing by
placing 2 pieces of
4x4 gauze over the
catheter exit site

Coil the catheter

over the gauze then
apply the second
4x4 gauze
opverlapping the
gauze on the other
side of the exit site

After applying the

second layer of
gauze, place
transparent film
dressing on top of
the dressing

Tape the transfer set

to patients skin
comfortably to
minimize excessive
tension on the exit
site.

Conclusion

PD catheter-related exit site infections

remain a significant source of morbidity
and technique failure among PD
patients.
Prompt diagnosis, early treatment and
good exit site care can decrease exit
site complications and improve catheter
survival.

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