Survey of exit-site management practices of peritoneal dialysis in Japan

Catheter exit-site infection is a major cause of withdrawal from peritoneal dialysis (PD). However, methods for caring for the peritoneal catheter and exit sites are not established and vary among facilities. No survey has been conducted on exit-site management in Japan. Here, we aimed to identify successful examples that led to best practices.

The Japanese Society for Peritoneal Dialysis-led PD-related infection project was launched in 2023, under which a survey was conducted at 14 facilities nationwide that provide PD therapy. The survey content included questions about the timing of the initiation of exit-site care, the materials used in exit-site protection, and the disinfectants used for exit-site care.

Seventy-one percent of the exit-site direction was downward. In all facilities, the exit site was dressed immediately after its creation for several days up to a certain period. Many facilities started exit-site care within 1-2 weeks of PD initiation. Notably, 50% of the facilities did not use disinfectants. Twelve facilities used gauze or film dressings to protect the exit site. The catheter was secured in many facilities; however, the distance of fixation varied. The timing for starting a shower after exit-site creation was commonly 1-4 weeks post-surgery. Nine facilities allowed bathing without a cover, typically after > 1 month. Of these, 7 did not use Spa Clean.

These findings provide insights into exit-site care trends across facilities. Further studies and trials are needed to establish the best practice on exit-site care for Japanese patients undergoing PD.