Clinical effectiveness of different approaches to peritoneal dialysis catheter exit-site care

Abstract

The main aim of this review is to evaluate and summarise the best available evidence about peritoneal catheter exit site care to minimise the risk of infection. The specific review questions to be addressed are: •What is the most effective approach to managing peritoneal catheter exit sites during the initial post-operative period? •What is the most effective approach to the long term management of peritoneal catheter exit sites? Inclusion Criteria Types of participants Participants of interests are both adults and children (under 18) with chronic renal failure on maintenance peritoneal dialysis. Studies which analyse diabetic patients separately will be considered for inclusion as a subgroup analysis. Types of interventions Interventions of interest are those used to manage peritoneal catheter exit sites, both in the early post-operative period (from 0 to 14 days post insertion of the catheter), and the long term period (15 or more days post insertion). Interventions of interest include: •Dressing of exit sites, including type of dressing, frequency of dressing and technique (aseptic vs. clean) •Exit site skin care, frequency and type of skin care (or product used). •Education of the person with a peritoneal catheter, or a carer, on exit site management. •Prophylactic treatments involving topic antimicrobial agents or antiseptic and devices. Types of outcome measures The outcomes of interest are those related to the effectiveness of peritoneal catheter exit site care. These outcomes will include incidence of exit site infection and peritonitis.Outcome measures: •Incidence of tunnel or exit site infection: Number of patients with infection inside the tunnel or at the exit site. Infection can be defined as the presence of redness, inflammation, exuberant granulation tissue and purulent/bloody exudate associated with erythema and oedema. •Incidence of peritonitis: two positive (post dialysis cell count > 100 cells/ mm³ with >50% of polimorfonuclear leukocytes), peritoneal liquid cultures in an asymptomatic PD catheter carrier or a single positive in a PD catheter carrier with symptoms of peritonitis (such as abdominal pain, fever and cloudy peritoneal liquid). •Reappearance of the peritonitis (after two to four weeks, due to the same microorganism). •Lapse of time to the first episode of peritonitis. •PD Catheter removal. •Readmission rates related to peritonitis. •Failure of the procedure (transfer from PD to haemodialysis). •Death caused by peritonitis