Prevention of peritoneal dialysis catheter-related infections.

There is a significant correlation between patient morbidity and peritoneal dialysis-associated catheter-related infections. Infection occurs when barriers to microorganism invasion are disrupted. To establish and maintain strong barriers against this invasion, care must be taken with placement of the catheter and with short- and long-term maintenance. There must be particular emphasis on planning placement of the catheter. Exit-site selection, type and configuration of the catheter, whether the catheter will contain one or two cuffs, and whether placement will be midline or lateral are all important factors to be considered. Tips are offered to enhance barrier establishment as the catheter is placed, as is a discussion of postplacement exit-site and wound care, and exit-site care after healing has occurred. Finally, the importance of recognizing catheter-related infections is emphasized and four types of infection are defined. Given the anecdotal nature of much of the material presented and the lack of well-defined clinical research on the subject, carefully designed randomized prospective studies are needed to determine the best method for both catheter placement and maintenance.