Peritoneal Dialysis Catheter Insertion Guidelines

Infection Prevention and Management

The Infectious Diseases Society of America recommends using maximal sterile barrier precautions, including cap, mask, sterile gown, sterile gloves, and sterile full body drape during insertion, and preparing skin with 0.5% chlorhexidine preparation with alcohol 1, 2
If chlorhexidine is contraindicated, the Infectious Diseases Society of America suggests using tincture of iodine, an iodophor, or 70% alcohol, and allowing antiseptics to dry according to manufacturer's recommendations prior to catheter placement 1, 2
The Infectious Diseases Society of America advises using either sterile gauze or sterile, transparent, semi-permeable dressing to cover the catheter site, replacing dressings if they become damp, loosened, or visibly soiled, and monitoring the catheter site visually when changing the dressing or by palpation through an intact dressing 2
For Aspergillus peritonitis, the Infectious Diseases Society of America recommends removal of peritoneal dialysis catheter and intraperitoneal dialysis with AMB, in addition to IV administration of AMB 5

The American Journal of Kidney Diseases notes that inflammatory or ischemic bowel disease and frequent episodes of diverticulitis increase risk of peritonitis, and abdominal wall or skin infection can lead to contamination of the catheter exit site 3, 4
The American Journal of Kidney Diseases states that morbid obesity poses challenges in catheter placement, healing, and providing adequate dialysis, and severe malnutrition compromises wound healing and may not tolerate peritoneal protein losses 3, 4
The American Journal of Kidney Diseases recommends allowing adequate healing time (6-16 weeks) after placement of prosthetic devices or materials to avoid leakage or peritonitis, and considering the risk of bacterial seeding during hemodialysis for patients with vascular grafts 3