The use of povidone iodine in exit site care for patients undergoing continuous peritoneal dialysis (CAPD)

There is no standardized approach to exit site care and the treatment of catheter-related infections. In this study 32 children (age range 1 month -15 years) receiving chronic peritoneal dialysis received an exit-site care regimen using either soap or Povidone-iodine as the primary antiseptic. Therapy of exit-site and tunnel infections consisted of either intravenous Vancomycin (15 mg/kg initially, then 8.5 mg/kg every four days for three doses) or a combination of oral Dicloxacillin (50 mg/kg/day) and oral Rifampin (20 mg/kg/day) for 14 days. In all, there were 48 catheter related infections in 270 patienttreatment months (one case per 5.6 patient treatment months). There was no significant difference in the frequency of infection between the two antiseptic groups. Antibiotics eradicated the infection in all but one patient and in none of these patients did peritonitis complicate an exitsite/tunnel infection.

Download Full-text

A Retrospective Sequential Comparison of Topical Application of Medicated Honey and Povidone Iodine for Preventing Peritoneal Dialysis Catheter-Related Infections

Peritoneal Dialysis International ◽

10.3747/pdi.2017.00224 ◽

2018 ◽

Vol 38 (4) ◽

pp. 302-305

Author(s):

Tayler F.L. Wishart ◽

Laraine Aw ◽

Karen Byth ◽

Gopala Rangan ◽

Kamal Sud

Keyword(s):

Peritoneal Dialysis ◽

Cumulative Incidence ◽

Povidone Iodine ◽

Incidence Rates ◽

Diabetic Patients ◽

Peritoneal Dialysis Catheter ◽

Exit Site ◽

Increased Risk ◽

Multicentre Cohort Study ◽

Nasal Mupirocin

Application of medicated honey (MH) to peritoneal dialysis (PD) catheter exit sites has been found to be as effective as intra-nasal mupirocin for preventing PD catheter-related infections (CRIs), but was associated with increased risk for CRIs in diabetics. The efficacy of topical MH as a prophylactic agent has not been compared with the exit-site application of povidone iodine (PI). This retrospective multicentre cohort study compared cumulative incidence rates of PD CRIs (peritonitis or exit-site infections) and the number of PD CRIs observed per patient over the study period with PD exit-site application of MH or PI, in both diabetic and non-diabetic patients. Outcomes were compared in incident patients in 2 eras: January 2011 – December 2012, when 147 received exit-site care with PI (PI group), and July 2013 – June 2015, when 171 patients applied MH (MH group). Patients were followed until technique failure, death, transplant, or end of study treatment era. Cumulative incidence of PD CRIs was higher in the PI group (hazard ratio [HR] = 1.7, 95% confidence interval [CI] 1.1 – 2.6, p = 0.019) and the benefit of MH was not modified by diabetic status (present/absent, interaction p = 0.723). A similar trend was observed in the cumulative incidence of peritonitis (HR = 1.6, 95% CI 0.99 – 2.6, p = 0.059). After adjusting for months of exposure, the rate ratio for PD CRIs was 1.58 for PI compared to MH (95% CI, 1.03 – 2.42, p = 0.035). We conclude that exit-site application of MH is more effective than PI in preventing PD CRIs, and this effect is not modified by the presence or absence of diabetes.

Download Full-text

Chronic exit-site care using povidone–iodine versus normal saline in peritoneal dialysis patients

Kidney Research and Clinical Practice ◽

10.1016/j.krcp.2014.07.005 ◽

2014 ◽

Vol 33 (3) ◽

pp. 119-120

Author(s):

Jun Young Do

Keyword(s):

Peritoneal Dialysis ◽

Normal Saline ◽

Povidone Iodine ◽

Dialysis Patients ◽

Exit Site

Download Full-text

The Efficacy of Exit Site Povidone-Iodine Ointment in the Prevention of Early Peritoneal Dialysis-Related Infections

American Journal of Kidney Diseases ◽

10.1016/s0272-6386(97)91130-6 ◽

1997 ◽

Vol 29 (5) ◽

pp. 763-768 ◽

Cited By ~ 17

Author(s):

Nancy M Waite ◽

Nancy Webster ◽

Manuel Laurel ◽

Michael Johnson ◽

lgnatius W Fong

Keyword(s):

Peritoneal Dialysis ◽

Povidone Iodine ◽

Exit Site

Download Full-text

Comparison of exit site infection and peritonitis incidences between povidone-iodine and normal saline use for chronic exit site care in peritoneal dialysis patients

Kidney Research and Clinical Practice ◽

10.1016/j.krcp.2014.05.030 ◽

2014 ◽

Vol 33 (3) ◽

pp. 144-149 ◽

Cited By ~ 7

Author(s):

Su Mi Lee ◽

Hwa Seong Nam ◽

Eu Gene Jeong ◽

Young Ki Son ◽

Seong Eun Kim ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Normal Saline ◽

Povidone Iodine ◽

Site Infection ◽

Dialysis Patients ◽

Exit Site ◽

Exit Site Infection

Download Full-text

Exit-Site Care in Austrian Peritoneal Dialysis Centers — a Nationwide Survey

Peritoneal Dialysis International ◽

10.1177/089686080902900319 ◽

2009 ◽

Vol 29 (3) ◽

pp. 330-339 ◽

Cited By ~ 28

Author(s):

Gertrude Kopriva–Altfahrt ◽

Paul König ◽

Michael Mündle ◽

Friedrich Prischl ◽

Johannes M. Roob ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Infection Rate ◽

Sodium Hypochlorite ◽

Povidone Iodine ◽

Nationwide Survey ◽

Infection Rates ◽

Exit Site ◽

Exit Site Infection ◽

Staff Members ◽

Octenidine Dihydrochloride

Background Catheter-associated infections markedly contribute to treatment failure in peritoneal dialysis (PD) patients. There is much controversy surrounding prophylactic strategies to prevent these infections. Methods In this nationwide multicenter study we analyzed strategies to prevent catheter-associated infections as performed in Austrian PD centers in 2006. A questionnaire was sent to all 23 PD centers in Austria. Results Ten different catheter models were used in the 332 patients being treated in the 23 Austrian PD centers. Systemic antibiotics prior to catheter placement were given by 17 of the 23 PD centers (glycopeptides, n = 7; cephalosporins, n = 10). Nasal swabs were taken preoperatively by 17 PD centers; nasal Staphylococcus aureus carriers were treated prophylactically with mupirocin cream in 15 of these centers. Dressing change was routinely performed in 318 of 332 chronic PD patients (nonocclusive film dressing, n = 58; gauze dressing, n = 260). Disinfectants for chronic exit-site care included povidone iodine ( n = 155), sodium hypochlorite ( n = 31), povidone iodine + sodium hypochlorite together ( n = 102), and octenidine dihydrochloride/phenoxyethanol ( n = 17). Water+non-disinfectant soap or 0.9% sodium chloride was administered as a cleansing agent to the exit site by 27 patients. Routine S. aureus screening (nasal and/or exit-site swabs) in chronic PD patients was performed in 12 PD centers; carriers were treated with mupirocin cream in 11 of these centers. Dialysis staff members were screened for S. aureus in 8 PD centers and spouses were screened for S. aureus in 5 PD centers. The overall exit-site infection rate was 1 episode/43.9 patient-months, tunnel infection rate was 1 episode/88.9 patient-months, and peritonitis rate was 1 episode/51.0 patient-months. Patients of centers that have installed a prophylaxis protocol for treating S. aureus carriers had lower mean infection rates compared with those not using such a protocol. Conclusion Various individual prophylactic strategies are used to prevent catheter-associated infections in Austrian PD centers. Infection rates are within the range reported in the literature. There is still scope for improvement in some centers ( e.g., by establishing a prophylaxis protocol).

Download Full-text

Double purse-string around the inner cuff of the peritoneal catheter: A novel technique for an immediate initiation of continuous peritoneal dialysis

The International Journal of Artificial Organs ◽

10.1177/0391398819891735 ◽

2019 ◽

Vol 43 (6) ◽

pp. 365-371

Author(s):

Antonio Scalamogna ◽

Luca Nardelli ◽

Francesca Zanoni ◽

Piergiorgio Messa

Keyword(s):

Peritoneal Dialysis ◽

Rectus Muscle ◽

Infectious Complications ◽

Peritoneal Dialysis Catheter ◽

Exit Site ◽

Bleeding Events ◽

Dialysis Therapy ◽

Purse String ◽

Catheter Implantation ◽

Continuous Peritoneal Dialysis

International guidelines recommended a delayed start of peritoneal dialysis at least 2 weeks between catheter insertion and continuous peritoneal dialysis therapy initiation (break-in period). Up to now, the optimal duration of the break-in period is still unclear. The aim of our study was to evaluate in patients, with immediate initiation of continuous peritoneal dialysis, the efficacy of a double purse-string around the inner cuff in preventing mechanical and infectious complications either in semi-surgical or surgical catheter implantation. From January 2011 to December 2018, 135 peritoneal dialysis catheter insertions in 125 patients (90 men and 35 women, mean age 62.02 ± 16.7) were performed. Seventy-seven straight double-cuffed Tenckhoff catheters were implanted semi-surgically on midline under the umbilicus by a trocar, and 58 were surgically implanted through the rectus muscle. In all patients, continuous peritoneal dialysis was started immediately after catheter placement. Mechanical and infectious catheter-related complications during the first 3 months after initiation of continuous peritoneal dialysis were recorded. The overall incidence of leakages, catheter dislocations, peritonitis, and exit-site infections was 4/135 (2.96%), 2/135 (1.48%), 14/135 (10.3%), and 4/135 (2.96%), respectively. Regarding the incidence of catheter-related complications, no bleeding events, bowel perforations, or hernia formations were observed with either the semi-surgical or surgical technique. Double purse-string technique around the inner cuff allows an immediate start of continuous peritoneal dialysis both with semi-surgical and surgical catheter implantation. This technique is a safe and feasible approach in patients needing an urgent peritoneal dialysis.

Download Full-text

Comparison Of 2% Chlorhexidine And 70% Alcohol Swab Versus 10% Povidone- Iodine Solution In Preventing Peritoneal Dialysis Exit Site Infection

Nephrology & Renal Therapy ◽

10.24966/nrt-7313/100036 ◽

2020 ◽

Vol 6 (2) ◽

pp. 1-8

Author(s):

Issa Al Salmi ◽

Keyword(s):

Peritoneal Dialysis ◽

Renal Replacement Therapy ◽

Povidone Iodine ◽

Site Infection ◽

Iodine Solution ◽

Exit Site ◽

Exit Site Infection ◽

Different Types ◽

Povidone Iodine Solution

Peritoneal Dialysis (PD) utilization increases gradually due to increase of patient's awareness for different types of Renal Replacement Therapy (RRT). Hence, in order to be successful with PD program, we need to build strong strategies to improve patients’ quality of care. One of the risks associated with PD is the Exit-Site-Infection (ESI).

Download Full-text