Goal: The peritoneal dialysis catheter dressing change is completed using aseptic technique without trauma to the site or patient; the site is clean, dry, and intact, without evidence of inflammation or infection.
1. Bring necessary equipment to the bedside stand or overbed table.
2. Perform hand hygiene and put on PPE, if indicated.
3. Identify the patient.
4. Close curtains around bed and close the door to the room, if possible. Explain what you are going to do and why you are going to do it to the patient. Encourage the patient to observe or participate if possible.
5. Adjust bed to comfortable working height, usually elbow height of the caregiver (VISN 8 Patient Safety Center, 2009). Assist the patient to a supine position. Expose the abdomen, draping the patient’s chest with the bath blanket, exposing only the catheter site.
6. Put on unsterile gloves. Put on one of the facemasks; have patient put on the other mask.
7. Gently remove old dressing, noting odor, amount and color of drainage, leakage, and condition of skin around the catheter. Discard dressing in appropriate container.
8. Remove gloves and discard. Set up sterile field. Open packages. Using aseptic technique, place two sterile gauze squares in basin with antimicrobial agent. Leave two sterile gauze squares opened on sterile field. Alternately (based on facility’s policy), place sterile antimicrobial swabs on the sterile field. Place sterile applicator on field. Squeeze a small amount of the topical antibiotic on one of the gauze squares on the sterile field.
9. Put on sterile gloves. Pick up dialysis catheter with nondominant hand. With the antimicrobial-soaked gauze/swab, cleanse the skin around the exit site using a
circular motion, starting at the exit site and then slowly going outward 3 to 4 inches. Gently remove crusted scabs, if necessary.
10. Continue to hold catheter with nondominant hand. After skin has dried, clean the catheter with an antimicrobialsoaked gauze, beginning at exit site, going around
catheter, and then moving up to end of catheter. Gently remove crusted secretions on the tube, if necessary.
11. Using the sterile applicator, apply the topical antibiotic to the catheter exit site, if prescribed.
12. Place sterile drain sponge around exit site. Then place a 4 4 gauze over exit site. Remove your gloves and secure edges of gauze pad with tape. Some institutions recommend placing a transparent dressing over the gauze pads instead of tape. Remove masks.
13. Coil the exposed length of tubing and secure to the dressing or the patient’s abdomen with tape.
14. Assist the patient to a comfortable position. Cover the patient with bed linens. Place the bed in the lowest position.
15. Put on clean gloves. Remove or discard equipment and assess the patient’s response to the procedure.
16. Remove gloves and additional PPE, if used. Perform hand hygiene.
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