PD people: What's your exit site routine?

[kickingandscreaming]

Having recently just recovered from an exit site infection, I am keenly interested in how others maintain their sites.  Before the infection I wasn't using any anti-microbial cream (got a rash from what was originally using).  Now I'm supposed to use it all the time.  A very close friend of mine is head of Infectious Diseases at a major NYC hospital and when she heard that I was to use mupirocin or gentamicin daily, she was quite concerned about building up an antibiotic resistance situation.  I'm not sure what to think.

What has been working for you?

[Charlie B53]

My monthly Clinic just happened to be today.  Dr, Nurse and I had this very discussion.  I have been on PD three years in May and have been using the mupirocin almost from the start.

Dr was talking about that very thing, bacteria building a tolerance and we decided when this tube gets low to switch to the gentamiocin for a period.   Eventually switching back, but giving a length of time.

Back up a ways.  When I had my cath placed, I was part of a study using a particular strain of bee honey instead of any antibiotic.  It was about three months and every clinic the researcher would take pictures to document how quickly I was healing.

UN-pasteurized honey has some very good qualities.  The natural enzymes are not only good as a food source but are being proven to have a natural antibacterial effect.

I ALWAYS apply the a/b with every dressing change.  It least, that is how my Nurse taught me.

I hope your infection was minor and has been cured easily.  It always has the potential to go bad in a hurry.

Take Care,

Charlie B53

[kickingandscreaming]

Thank you, Charlie.  I actually just ordered a tube of Medihoney gel.  It's Manuka honey, a special New Zealand honey used for medicinal purposes.   I'm wondering why you are using conventional abx when you have already had a positive experience with the honey.  And I'm also wondering what the on/off strategy is for switching between abx creams.  What is the duration for each?  I know that if you use something too long, the microbes can become resistant.  Certain ones survive the use of abx and those replicate and create a super race of microbes.  Since honey is also an abx--albeit a natural one, I wonder if the same thing happens.

BTW, my infection is now totally resolved... and I don't want one again.  I have to find a way that protects the catheter from yanks and snags.  I will be buying some PD belts (as I'm sensitive to tape).

[Charlie B53]

Yanks and snags use to be a serious problem as I can feel them.  The area of my site is numb from nerve damage during my by-pass surgery.   Even using the PD Belt I had problems doing manual exchanges for the first years.  I never realized, cause I couldn't feel it, how the drain bag position on the floor and having my IV pole on my right side tended to pull against the site, elongating the opening.  Nurse was ALWAYS digging in there with those silver tipped Q-tips to cauterize the site.  I never felt it on the very surface, but once she'd get down inside, WOW, like a wasp sitting there and dancing, for an hour.

We finally figured to switch my pole to the left side, that helped a lot.

One of my Nurses showed me another method of bandaging which supports the hose very well such that tugs and pulls are well contained and cannot relay back to the site.

Think of your site as a small lclock face with the site the center.  Lay the first 'holed' patch on and have one side of your tape peeled and ready.  We bend our hose over to one side or another to lay the second patch one.  Alternate this direction on the clock face with every dressing change.  Like noon, 3, 6, 9.  This way any 'side' pressure inparted to the exit site is alternating and less likely to cause an elongation.   Now just before taping, make a smal circle of hose the size of the gauze pad or a hair larger/smaller,  Hold this hose circle on top of the second patch as you carefully apply the tape.  The tape now has contact with a massive amount of hose so any tug, pull, snag is well contained by the larger tape and no disruption of the actual site.

This uses up a length of hose enough that I just tape the remainder to the top of my abdomen slightly off to one side.

It has been working quite well for two years now.

Next Clinic I'lll be sure to ask how long we should use any abx before rotating brands.

I still have maybe half that tube of honey.   Since it was a controlled study my Neph insisted I use the abx once the study ended.  But I see no reason if someone has a source to continue with it.  Mother Nature is a wise old woman and knows a hell of a lot more than most ALL of our Dr's put together.

And if I ever get hungry enough I can spread some on toast!

It wasn't that many years ago archaeologist found sealed jugs estimated to be over two thousand years old, and the food stuff inside was still perfectly edible.   This may have been on the ocean floor, I don't remember.  But it was honey.  Will not mold, will not go rancid, may crystallize and darken is all.

[kickingandscreaming]

Think of your site as a small lclock face with the site the center.  Lay the first 'holed' patch on and have one side of your tape peeled and ready.  We bend our hose over to one side or another to lay the second patch one.  Alternate this direction on the clock face with every dressing change.  Like noon, 3, 6, 9.  This way any 'side' pressure inparted to the exit site is alternating and less likely to cause an elongation.   Now just before taping, make a smal circle of hose the size of the gauze pad or a hair larger/smaller,  Hold this hose circle on top of the second patch as you carefully apply the tape.  The tape now has contact with a massive amount of hose so any tug, pull, snag is well contained by the larger tape and no disruption of the actual site.

I'm having trouble visualizing this.  I only use one bandage, an island bandage that much more than cover the exit site.  It's mostly gauze with a band of adhesive around the edge.  So I don't use the "holed patch" (not even sure what that is).  I just put on the abx and stick the island dressing over in one fell swoop.  I also have a rather short catheter so lots of twirling and spiraling wouldn't work for me.  I can just get it so that I can work with it with nothing to spare.  I do cover about 1" of the catheter with the dressing and that helps it snag less.

[Charlie B53]

I understand.   My dressings come  with both gauze pads in one package, about 2 X 2 inch pads.  The first one has a small hole in the center the size of the hose and four slot radiating out like a clock, one all the way to the edge so you can slide it over the hose to place it directly ono the site.,, Then use the second solid patch to cover the first.  They also provide me with Stretch Cover roll.  About 4 inch wide roll of stretch tape that sticks very well.   I use about a 5 inch piece to cover everything.   By making that 'curl of hose it has massive contact area with the tape.   You may consider using additional tape, then make that small curl in the hose, lay it directly upon your current dressing the tape it down.  This will absorb ALL shock and strain without disturbing the original dressing and the site.

Someday I will have to figure out what went wrong and why I cannot get pictures off my phone any longer.  It's not me, so it must be my computer has an attitude, again.

[Fabkiwi06]

I got a few boob tubes to wear around my middle to keep everything in place. They're pretty easy to find in stores and online.

For those not on the up and up of lady underthings, boob tubes are spandex tubes that are typically worn as bras. However, they work a treat for preventing gapped pants and, now, preventing catheter snags.

As far as cleaning, I have pretty much the same routine as everyone else. I try to clean with soap in the shower daily, but if I don't I will use the solution they gave me.

[Charlie B53]

.........in the shower daily, but if I don't I will use the solution they gave me.

I have to ask,  are you covering or wraping the cath so to not get the fittings wet?


Training drilled it into me that water 'could' soak into the threads holding the fittings together and foster bacterial growth.  Nurse taught me to wrap the major length of the cath with Handi-Wrap, I prefer 'Press -n-Seal', to keep those fittings dry.

I also used to wipe the cath 'clean' with alcohol pads until I recently learned here at IHD that alcohol wipes are NOT sterile unless the package spicifies sterile.   Now I use Betedine wipes to sterilize then alcohol to clean up the stain.

Nurse gave me some other type of wipes, same size as the alcohol wipes but these work great to remove the tape residue from the cath hose.  Alcohol wipes will work, just take a lot more time and effort.

[stayingalive]

When I shower I use Dial antibacterial liquid soap and my hands.  Told regular bar soap and wash clothes were off limit.  Also, my site is uncovered as I do this.  I pat myself dry around cath site, put on antibacterial cream and cover with 2...2x2 gauze pads just taped on.  I used a pd belt that really doesn't bother me all too much.  I wipe my hose using the same liquid as I use when disinfecting before hooking to machine.  (sorry don't remember the name of it off-hand)  almost 2 years of PD and no problems so far.

[Charlie B53]

I clean the site, but am always careful to wrap the hose and fittings so to keep them DRY.

[PrimeTimer]

Imported Manuka honey in a jar looks to be anywhere from $30-40 and nearly $20 for just a small tube of it! Holy crap!!

[Charlie B53]

LOL

Can you put a price on 'Magic'?   (Big snicker)

Just glad that the VA or actually it was the University of Missouri doing the study.  SOMEBODY else paid for it.  I was given the tube and told to use it instead of a topical antibiotic.  And it worked wonderfully.  I am usually a rapid healer and they are surprised that I am diabetic.  But I've always healed quickly as far as I can remember.  Must be something in my DNA.

Anyway, they documented with pictures at every visit, told me I was a couple of weeks ahead of the 'pack' of patients they were following.

I used it sparingly and half maybe half the tube left.  Doubt it will even 'go bad'.

[kickingandscreaming]

Imported Manuka honey in a jar looks to be anywhere from $30-40 and nearly $20 for just a small tube of it! Holy crap!!

I just picked up a tube of Medihoney from Amazon for $15.

[Fabkiwi06]

.........in the shower daily, but if I don't I will use the solution they gave me.

I have to ask,  are you covering or wraping the cath so to not get the fittings wet?


Training drilled it into me that water 'could' soak into the threads holding the fittings together and foster bacterial growth.  Nurse taught me to wrap the major length of the cath with Handi-Wrap, I prefer 'Press -n-Seal', to keep those fittings dry.

I also used to wipe the cath 'clean' with alcohol pads until I recently learned here at IHD that alcohol wipes are NOT sterile unless the package spicifies sterile.   Now I use Betedine wipes to sterilize then alcohol to clean up the stain.

Nurse gave me some other type of wipes, same size as the alcohol wipes but these work great to remove the tape residue from the cath hose.  Alcohol wipes will work, just take a lot more time and effort.

I am wrapping the tubes - love the press and seal idea. I've been using sandwich bags and a twist tie.

[kickingandscreaming]

I was never instructed to protect the catheter from water.  I was told to let the shower wash over it. Uh oh.  But every time I connect and disconnect I wipe the transfer set down with Alcavis.

[Charlie B53]

I have the Alcavis, I just wasn't taught to use it for that.  But I like that idea very much.

I am very much surprised you were not taught to wrap the transfer set to keep it dry.  There reasoning is we cannot dry inside the threads of the connector.  That it is possible for bacteria to grow with that moisture. 

I specifically asked then about getting my site wet.  That is O.K. as we dry it and add  the antibacterial there to prevent bacterial growth.

You may want to talk with your team again about this, or just learn to wrap it, just for the added protection.

I would recommend your error on the side of caution.

I was surprised to learn from a PD Nurse yesterday at the Hospital. (A whole nother story why).  I don't know if this is everywhere or only within patients of their Clinic.  PD Patients are only allowed two peritoneal infections, then they are changed over to hemo. 

I cringed at the idea.  And I intend to be even MORE cautious handling my transfer set.  As needle phobic as I am hemo would be a serious problem for me.
 

[Charlie B53]

Forgot to mention.

Keeping the transfer set dry.  As a retired marine mechanic I still work on a few boats now and then.  Sometime while out on the water as if is very helful to see/hear/feel how it runs  working far better than running it on the garden hose in the yard.  A world of difference.

I have been told, repeatedly, and forcefully.  NO FALLING OFF THE BOAT!!  No matter how hot it is and how cool the water feels, I am no longer allowed to get in, because of the possibility of the transfer set getting wet.    Damn!  Pretty much ruins my Summers.   Same goes when fishing the rivers and creeks.   It is not recommended to even wade as the possibility of slipping on a wet rock and falling in.   

Does this get any better?

No.

[Charlie B53]

I am still NOT selling my old boat!