Recommendations for Exit Care

Prevention of peritoneal dialysis (PD) catheter infection begins with good surgical practice for catheter implantation and includes appropriate preoperative patient preparation and surgical technique as well as postimplantation care (1,2). Because antibiotic penetration into the coagulum is poor, antibiotics should be present in sufficient concentration in the blood and tissue fluids before the coagulum is formed. This can be achieved if systemic antibiotics are given preoperatively. In an accompanying manuscript we showed that early colonization of exits is predominantly by Grampositive bacteria; however, some exits were colonized by Gram-negative bacteria, and these cases developed early infection (3). Therefore, systemic coverage for both Gram-positive and Gram-negative organisms seems desirable for prophylaxis. Topical antibiotics may not be effective during the early postimplantation period, because they can be washed away by drainage from the exit. The evening preceding surgery the patient should shower using a long-Iasting disinfectant. The surgical preparation of the integument should be similar to that used for any major surgery. Perfect hemo stasis during surgery is of utmost importance in order to avoid hematoma formation along the catheter tunnel, because hematoma predisposes to early infection. The surgical incision and exit site should be covered with several layers of absorbent gauze dressing. It is important to immobilize the catheter as well as secure the dressings. Semipermeable dressings applied directly to the wound and occlusive dressings