MAINTAINING HEALTHY PERITONEAL-DIALYSIS CATHETER ACCESS

The care of a ''perfect exit site'' for a peritoneal dialysis (PD) cat heter should involve catheter immobilization, protection from trauma, the use of liquid soap and water for daily care, and the use of 3% hyd rogen peroxide only for crust removal. The ''perfect exit site''-one f ree from trauma and bacteria-can be maintained with meticulous care. T here are several issues related to peritoneal catheter access, however , which may prohibit patients from obtaining the ''perfect exit site'' and from maintaining it with optimal care. Catheter leaks-defined as dialysis solution leakage around the chronic catheter exit site-presen t a problem to PD patients, causing them to either halt PD or to switc h to hemodialysis. Leaks can occur from strenuous activity or form old er catheter sites, and are most common in diabetics, obese patients, a nd elderly patients. Exit site infections are major obstacles in the m aintenance of peritoneal dialysis access and often lead to peritonitis and catheter loss. Efforts to address these problems by dialysis cent ers include the use of prophylactic antibiotics as well as topical 2% acetic acid in approximate hypertonic saline solution. Meticulous pati ents training and monitoring are worth the time and effort required by the dialysis center staff. This attentiveness helps patients feel com fortable and at ease with their catheters. Long-term catheter success also relies on surgical technique and physician involvement to prevent problems from occurring due to initial catheter placement. Ongoing im provements in patients outcomes result from dialysis centers sharing t heir clinical and practice improvements regarding catheter leaks, non- functional catheters, exit site infections, catheter insertion, therap y advancement, preassessment, patient education, and physician involve ment.