Opinion on exit-site care recommendations

Dear Editor,

In the ISPD Catheter-related Infection Recommendations: 2023 Update (1), there are two recommendations regarding the exit-site care that seem to be contradictory. The first recommendation (p. 206) suggests daily application of topical antibiotic cream on the catheter exit site, whereas the fourth recommendation (p. 206) suggests that the exit site should be cleansed at least twice weekly and every time after a shower or vigorous exercise. The optimal frequency of exit-site care has not yet been determined, ¹ but a frequency of less than twice a week has been associated with higher odds of catheter-related infections. ²

We believe that these two recommendations cannot be combined and applied as part of a peritoneal dialysis (PD) patient’s exit-site care routine. In particular, if the exit site is cleansed twice weekly, daily application of antibiotic cream is not feasible and, conversely, if the dressing is removed every day for the application of antibiotic cream, it would seem logical to also clean the exit site daily.

It is known that PD patient training programmes vary widely around the world ³ and reported clinical practices might deviate from ISPD guideline recommendations in many countries. ⁴ Consequently, it is important that the guidelines addressed not only to physicians and nurses but also to patients and caregivers should be stated in a clear and comprehensible way in order to minimise confusion and achieve better compliance.