BEST PRACTICE MANAGEMNET CATHETER EXIT SITE CARE

Best practice managemnet catheter exit site care in peritoneal dialysis patient

Best practice managemnet catheter exit site care in peritoneal dialysis patient

Catheter insertion' of a patient has their peritoneal catheter inserted and begins PD. At the time of their peritoneal catheter insertion the patient may receive a prophylactic intervention or a treatment of S. aureus carriage. Following the first 4 weeks after insertion of the catheter, a patient may remain on PD with or without carriage of S. aureus. Patients in this state could potentially also develop an infection, transfer to HD or die.

In this state, the patient receives PD and may also receive routine checks for the development of S. aureus carriage. The risk of developing carriage and hence the probability of moving to 'On PD with SA carriage' may be affected by the use of some form of prophylactic preventive treatment either at the time of catheter insertion (the first initial state of the model) or while on dialysis. Patients in this state could potentially also develop an infection, transfer to HD or die. 3. 'On PD with SA carriage'. Patients in this state are still on PD but are carriers of S. aureus. If S. aureus carriage were eradicated, the patient would move back to the state 'On PD without SA carriage'. The patient could suffer some form of infection although the risk of this happening may be affected by any of the methods of treating S. aureus carriage (antibiotic sprays, ointment or powders). Patients in this state could potentially also transfer to HD or die. 'Infection'. While on PD, a patient may suffer an exit-site infection, isolated tunnel infection or peritonitis. The infections may occur either separately or sequentially: exit site infection leading to tunnel infection leading to peritonitis. While in this state, patients face the risk of losing their PD tube and moving into temporary or permanent HD. Factors that could make a person move from PD are clearance failure, technique failure or recurrent peritonitis. The types of infection and there effects are: (a) Exit-site infection, which is treated with using a local treatment, systemic treatment or catheter change. (b) Isolated tunnel infections, which are treated using systemic treatments and/or catheter removal.

If S. aureus infection is not resolved, the catheter can be removed and the treatment modality switched to 'Temporary HD'. Non-resolution of S. aureus infection can ...