Which PD Exit Site Dressing is Better?

Is an occlusive dressing better to reduce exit site or tunnel infections? A semi-occlusive one? It made no difference, found a new analysis of 2,460 incident PD patients. Read the abstract.

Read the abstract » | (added 2017-11-13)

Tags: Chronic Kidney Disease, Dressing, Nursing, Peritoneal Dialysis

Striking Lack of Data on Infection Prevention in PD

A Cochrane database review of 59 randomized controlled studies revealed “striking” gaps in our knowledge about what really works to prevent infections in PD. Oral or topical antibiotics and topical disinfectants had uncertain benefits for exit site, tunnel infections, or peritonitis. Use of IV vancomycin prior to catheter placement may reduce the risk of early peritonitis. Antifungal treatments may reduce fungal peritonitis after antibiotics.

Read the abstract » | (added 2017-04-12)

Tags: Peritoneal dialysis

Urgent Start PD vs. HD

Which option is better if someone “crashes” into dialysis? A retrospective study was done of 178 people who started dialysis urgently between January, 2013 and December, 2014. Those who started PD had far fewer complications in the first 30 days. HD patients had more bloodstream infections. Survival was about the same for both groups.

Read the abstract » | (added 2016-12-09)

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Upper Abdominal PD Exit Site May Reduce Infection

A change in the exit site location may matter for PD. A non-randomized study of 147 catheter placements compared standard straight catheters to longer, swan-neck ones placed in the upper abdomen. Those with the upper abdominal catheters had far less exit site and tunnel infections. Peritonitis rates were similar.

Read the abstract » | (added 2016-02-09)

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Gentamycin Ointment For PD Exit Sites Did Not Increase Antibiotic Resistance

A review compared 10 years PD exit-site care using oral rifampin and mupirocin ointment (n=265) with 10 years of gentamycin cream (n=179). While the demographics were largely similar apart from race, there were significantly fewer gram-negative exit site infections using gentamycin, with very low rates of gentamycin resistant infections in either period.

Read the abstract » | (added 2015-12-10)

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Vascular Access Technique Audits Can Reduce Home HD Access Infections

Self-cannulation errors can lead to infections. A retrospective study of all prevalent home HD patients at the University Health Network in Canada looked at access infections between 2006 and 2013. Among the 92 patients who completed at least one vascular access audit, those with five or more errors had significantly higher infection rates. Longer duration on home HD was associated with higher error rates. Audits give nurses a chance to retrain patients and reduce future errors and infections.

Read the abstract » | (added 2015-11-11)

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PD Catheters: To Dress or Not to Dress?

Which is better for preventing exit site infections, a PD catheter dressing, or leaving a healed catheter open to the air? A prospective, randomized, controlled trial in Malaysia followed 108 patients for 2 years. All were instructed to wash the exit site daily with antibacterial soap. The dressing group (n=54) used povidone iodine, mupirocin ointment, sterile gauze, and tape. The non-dressing group did not. Of the 97 patients who completed the study, the results from both groups were similar.

Read the abstract » | (added 2015-10-15)

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Urgent Start PD: Safe and Effective

The first Canadian group to try urgent start PD followed 30 patients for a total of 3 years. They found no peritonitis or exit site infections in the first 4 weeks after catheter placements, three minor leaks that were managed conservatively, and four catheter migrations that were relocated without the need for surgery. The researchers concluded that urgent start PD is safe and effective for people who need to start dialysis and do not have an access.

Read the abstract » | (added 2015-10-15)

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Medihoney <i>Does</i> Equal Mupirocin for PD Infection Control

While Medihoney did not reduce overall PD infections, a substudy of the “Honeypot” trial did find positive results. Among 371 PD patients randomized to daily exit site antibacterial honey or nasal mupirocin (for staph carriers), rates of both exit site infections and peritonitis were equivalent. NOTE: Honey does not create antibiotic resistant bacteria, which is a plus.

Read the abstract » | (added 2015-08-08)

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Progress toward reengineering catheters to reduce infection

Can we eliminate exit site infections by redesigning catheters? Bioengineers are working on a way to create a biological seal that would keep germs out. A new device being tested uses a removable protective membrane that slowly grows out of the body, leaving a dry groove that reduces infections—at least in goats.

Read the abstract » | (added 2015-06-10)

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