Dressing Changes and Peritonitis Risks

Dressing Changes and Peritonitis Risks

Taking good care of Rowan’s PD catheter and the skin around the exit site is important to keep the catheter working well and to decrease the chance of infection. At a minimum, we have to change Rowan’s PD dressing every 7 days. We usually change it every 3-5 days because it often gets wet from being near his G tube, or the tape starts to peel up because of how active Rowan is these days.
Similar to connecting Rowan to his dialysis machine, dressing changes need to be done in a clean, sterile environment. That means we need to close the windows, turn fans off, put our dog in another room or outside, wear masks, and use sterile supplies. For each dressing change, we need a pair of sterile gloves, a saline wipe or adhesive remover wipe, a skin-barrier wipe, two masks, gentamicin drops, a new dressing, antibacterial skin cleanser, and sterile gauze. Usually, Justin will sit on one side of Rowan to help hold his legs and arms still so he doesn’t grab anything and I sit on the other side so that I can remove the old dressing, clean the site, and apply the medication and new dressing.
Rowan always does so well with this. He stays pretty still and usually looks very concerned when I take the old dressing off. Once it’s off, he wiggles and tries to touch everything so there is no way I could change his dressing without help! We also have to check the dressing site throughout the day to make sure there is no redness, drainage, or crust around the exit site. Any of these could be a sign of infection. Rowan often has some drainage, which has been normal for him, so if he does we just change the dressing and apply more medication to help dry it up.

Some important rules that we have to follow with Rowan’s dialysis catheter are:

+ Do not submerge the exit site (where the catheter comes out of his belly) in water, which means Rowan cannot take a bath or swim.
+ Keep the exit site clean and dry at all times and change immediately if it gets wet, dirty, or is falling off.
+ Do not use scissors, pins, metal clamps, or any other sharp objects on or around the catheter (this could cause a hole that would prevent dialysis from working and allows bacteria to get inside Rowan's body which could cause a serious infection called peritonitis).
+ The catheter should be secured at all times to prevent pulling and damage at the exit site.
+ A dressing must cover the exit site at all times.


The peritoneal cavity is the space between the abdominal wall and the organs in the abdomen. This space is sterile, which means it is free from germs. If germs get inside the peritoneal cavity, they can cause a serious infection called peritonitis.
Peritonitis can be caused by bacteria entering the body directly through the dialysis catheter, an infection of the tunnel area around the catheter that spreads to the peritoneal cavity, an infection of the exit site where the dialysis catheter leaves the abdomen, or issues with the bowel (such as constipation, diarrhea, or surgical procedures) that allow bacteria to cross into the peritoneal cavity.
Infants and young children have a higher risk of infection because their immune system is not well developed and the exit site is near the diaper area and/or g-tube area and can get soiled easily. Once infants started scooting and crawling on their bellies, they are at risk for damaging the exit site and catheter, or they may start grabbing and pulling at the catheter.
We have to call the dialysis nurses immediately if we notice any tears or holes in the catheter, if our child has a fever or abdominal pain, or if there is redness, swelling, or crusting around the exit site.
A way that the nurses taught us to look out for peritonitis is to remember the acronym F.A.C.T.
Flu-like illness/ symptoms
Abdominal pain, nausea, or vomiting
Cloudy dialysis drain fluid
Sometimes peritonitis can be treated with antibiotics through an IV or through the peritoneal dialysis fluid. If a peritonitis infection won't heal or keeps returning once it is healed, peritoneal dialysis has to be stopped and the patient would need to start a different form of dialysis. I will go into other forms of dialysis in another post, but the other options cannot be done at home and are harsher on the body than peritoneal dialysis.
It's a blessing that Rowan has been on PD for about 1.5 years now with no infections or serious issues. I pray that it stays that way until we can get him a kidney transplant! If you have any questions about peritoneal dialysis, comment below!

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