Exit site covering alternatives

[Savemeimdtba]

I was wondering if anyone here would have a better solution to things I have tried... I've been wearing a 4x4 island dressing over my exit site since March - needless to say it's a bit sore and raw all around the area (not the exit site itself).  I've tried taping a smaller gauze, it didn't stay in place, I've tried an ace bandage wrapped around my waiste.. too many curves for it to stay in place Right now, I have a piece of tissue taped around it lightly trying to let it heal... I wish I could go without covering it, but I can't quite wrap my mind around that yet.. I'm overly cautious with the whole area.  what do you guys do? 

[peleroja]

Wouldn't you know, the first person to respond is the black sheep of PD!  I only cover my exit site once a month, and that's when I visit the doctor.  Then I just use a large band-aid.  Adhesive tape of every kind, Tegaderm, island dressings, etc. just tear my skin apart, so I gave up covering my exit site with anything but my clothing.  Never got an infection in 6 years.  Don't know if I'm lucky or it has something to do with the fact that it's in my chest instead of my abdomen.

[paul.karen]

I am having the same problem.
I thought about trying the ace bandage but im a procrastinator.

A tube top would likely work, if tight enough you could still use your regular dressing without using the tape part.

Maybe use a bigger covering and alternate weekly so the tape isnt always in the same spot day after day??

[Savemeimdtba]

tube top is a good idea!  I just want something that keeps it from moving you know.. I'm not so much scared of infection as I am it getting hit or pulled, I just feel better when something is keeping it down.  I keep it taped as well but you know what I mean. 

[looneytunes]

My hubby had the same problem for a while.  Tape of any type tore up his skin.  He finally started leaving it uncovered and just kept the waist of his pants down lower and tucked the catheter into the waistband.  After about a month, he was all healed up and now he just lets the catheter hang down his leg. 

[Savemeimdtba]

not quite what I mean, Looneytunes, but thank you for your response I wear a PD belt to keep the catheter in place around my waste.  your husband should look into that, from what my nurses have told me, they don't reccomend letting it hang down your leg, could get caught on something.. plus the PD belt is really userful and you can't even tell it's there! 

[KICKSTART]

I used dressings called Mepore for nearly 5 years .. no probs  but i bet you dont have them over there ? ps we were not allowed to leave our exit sites uncovered and i dont know if worth adding , i never got peritonitis or an infection in all that time !

[*kana*]

I just rotate my little piece of gauze so I'm not taping in the same place.  You can even ask for/buy some bigger gauze pads. 
This might seem a little gross but what about not changing it everyday and just using bath clothes to wash up?

[rookiegirl]

When I was on PD for 1.5 years, I covered my exit site 24/7.  I used 2-2X2 gauze folded in half.  Before taping the gauze, I used Getamacin cream on the exit site.  I took one 1 folded in 1/2 gauze, placed it about 1/4 inch from the botton of the exit site and taped off the bottom edge edge of the gauze, leaving excess tape so it will stick.  Then the other folded gauze, I placed on top of the exit site so it can overlap and taped the top of the gauze leaving excess tape so it will stick.  The tape I used is cloth tape because plastic and paper did not work for me.  Hope this makes sense.  This is how they trained me in my PD Clinic to allow the exit site some breathing room.

I used netting to hold the catheter tube in place.

[Jie]

In my clinic, it is optional for covering the exit site. The clinic allows only 2X2 for covering it. I got a special permission to get 3X3, so that I can alternate 2X2 and 3X3 daily to avoid taping the same spots.

[jennyc]

Hi,
I get the same problem. I try to alternate where i put the dressings. I also use a bandaid some days becuase it is less irritating. If i'm at home and not doing any cleaning i will leave it uncovered. To combat it moving around i usually tuck it into my pockets of my pants, doesn't pull or rip. With the tape, johnson and johnson make a nice white soft tape, (can't think of the name at the moment) and it doesn't seem to irritate as much as the orange one baxter supplies to us.

Also some days i simply cut around the outside of the dressing to make the sticky part smaller, sometimes i use two to make the area i'm covering larger so that the adhesive isn't always in the one place.

Also taking the dressing off in the shower or using clorhex to loosen it helps as it reduces the ripping motion when you remove them. I had blisters under the steri-strips when they came off my fistula after a week and a half on. I have lost a bit of skin around my wrist because of it.  So yeh, the adhesive is pretty horrid in those things.

My neph said its fine to leave it uncovered, the nurses also suggest to get over infection of the exit site to sit in the sunshine with the wound exposed for a few mins each day (not long enough to burn you though). I, like you cannot leave it uncovered for any long period of time, although when i have its had no detrimental effect.

I use tape about 1" to 1.5" from the exit site to secure it in place. I loop the tape around the catheter, pinch it closed under the tubing and then place the remainder on the skin, this way it gives more strength, flexibility and only a small area of adhesive is touching the skin. Also this way if left for a few hours (or a day) it will be really strong and hold tightly in the shower without dropping.

Doing these things i only get irritations about 1 every 6 months sometimes less.

Cheers Jenny

[Lillupie]

Another thing to use are PD belts

Some insurance companies will pay for them. So, check to see if yours does. Here are some sites you can look at a Pd belt and compare prices.

http://www.fstubbs.com/pdbelt/index.htm
http://www.homedialysis.org/hpc/index.php?main_page=product_info&cPath=1_6&products_id=4
http://www.patientspride.com/index.html
http://www.healthcare-specialties.com/pdbelt.html
http://www.kidneystuff.com/index2.html

Lisa