PD Catheter question- exit site

[kickingandscreaming]

Whenever I change the dressing on my exit site I go through a mini-debate with myself.  Should I let the catheter just hang down and go with gravity?  Or should I position it to the left, right or up?  Is it a good idea to rotate the position so the exit site doesn't get "locked" in a certain position?  Would it make it more likely to snag the site by rotating?

My catheter is on the short side, so there isn't a lot of leeway for hooking it to my PD belt.  When it's pointing downward from my dressing, it makes it even shorter.  So that's why I consider rotating it at different angles.  Any opinions out there on this?

[Charlie B53]

Most definately rotate the direction it is 'leaning' as the hole will attempt to set in that direction.   When it does the PD Nurse will see it as the hole isn't nice and tight to the hose.  Any looseness leave uncovered 'flesh' exposed as there is NO SKIN inside.  If there is any wetness apearing the Nurse will cauterize that area with the silver nitrate stcks.  And it STINGS like a Wasp!

I redirect mine with every dressing change.   To keep the hose from pulling against the hole I make a small loop of the hose.  The loop laying on top of the gauze dressing so that the tape sticks to the whole loop, except that very small section from the actual hole, laid over and coming out from under the gauze.  All the rest of the loop is taped.  Enough that if I were to solidly pull on the transfer set the entire force is contained by the tape.  The hose at the hole never sees or feels any movement.

I really should takek a picturte or three as I change my dressing so everyone could clearly see what I am trying to explain.   My Chinese PD Nurse taught me this when I had so much trouble with my site.  That area is numb from nerve damaged during by-pass surgery.  I can't feel it if my hose is pulling against the site so I had to learn how to better protect it.  And this is working great.

[kickingandscreaming]

I'm glad I asked about rotation and that there is a clear answer.  I did start rotating it today. 

I redirect mine with every dressing change.   To keep the hose from pulling against the hole I make a small loop of the hose.  The loop laying on top of the gauze dressing so that the tape sticks to the whole loop, except that very small section from the actual hole, laid over and coming out from under the gauze.  All the rest of the loop is taped.  Enough that if I were to solidly pull on the transfer set the entire force is contained by the tape.  The hose at the hole never sees or feels any movement.

Although this sounds like a good solution, I don't think it would work for my catheter as it is considerably shorter than average (so says my PD nurse).  So I doubt that I could "tie up" a section of it by looping and taping and still have enough length to be able to get hold of it. 

[beckums70]

My nurses have always encouraged me to watch the natural direction that my tube tries to hang in, and tape it so that it DOESN'T rotate.  According to them, rotating it will cause the exit site to stretch and cause scabbing, which is very uncomfortable and risky as far as infection goes.

[kickingandscreaming]

My nurses have always encouraged me to watch the natural direction that my tube tries to hang in, and tape it so that it DOESN'T rotate.  According to them, rotating it will cause the exit site to stretch and cause scabbing, which is very uncomfortable and risky as far as infection goes. 

I totally agree with this.  I decided to try rotating it and I almost caused an infection as the rotating created a snag at the exit site and was very painful.  I now just let it fall where it wants to and tape it in place. 

[Charlie B53]

Of course you have to be careful about supporting the hose.  Mine must be about 10 inches before the twist valve connector, so it is easy for me to form a small loop just the size of the gauze pads we use for the dressing, and tape it down directly on top of the dressing.

I rotate the initial direction coming out of the skin, noon, 3,6,9, then noon again on the fourth dressing change.  This way there isn't that indentation in my skin and an elongation of the site hole.

If your cath is that short perhaps you should be asking this questions of your PD Nurse and Neph.  My set has a fitting, and then the next say 6 inches of hose to the actual valve connector/transfer set. The transfer set gets changed about twice a year.

[Fabkiwi06]

My nurse suggested (carefully and gently) rotating the tube to lead out the opposite side that I sleep on to help with triggering the machine in the middle of the night. I tend to sleep on my right, so the cath is secured to the left. It's helped a lot with my middle of the night beeps.

Otherwise, I was told the less I move it the better. I think picking a position that is comfortable for you is key, then letting it settle up around.