Can you tell me the current ISPD guidance on patients showering with a catheter (I.e. cover versus no cover) and if there are (or ever was) also an additional measure for patients to remove and clean their shower head? It seems to be a topic that comes up when discussing showering with a catheter, but I am not finding any evidence to support this practice.

Questions About PD

Stephanie B, Scientist from United states asked
Can you tell me the current ISPD guidance on patients showering with a catheter (I.e. cover versus no cover) and if there are (or ever was) also an additional measure for patients to remove and clean their shower head? It seems to be a topic that comes up when discussing showering with a catheter, but I am not finding any evidence to support this practice.

1 answer

Nurse Canada with members of the ISPD Nursing Liaison Committee January 30, 2020

We thank you for your question. First, in response to the part of your question on patients showering with a PD catheter, it is most important that, as recommended by Dr. Crabtree, the PD dressing on a newly implanted catheter should not be changed for 5 – 10 days, unless there are obvious signs of bleeding. This practice allows the PD catheter site to heal. The patient should not resume taking a shower until instructed by a home training nurse that it is safe to do so (1). In a recent survey of 42 North American PD centers, over 80% of sites used a non-occlusive dressing post-operatively, immobilized the catheter, and reported dressing changes done using sterile technique by a nurse. Over 80% of centers also instructed patients not to shower for at least 1 week or do heavy lifting (2).

Now, for guidance on practice once the patient’s PD catheter exit site is healed, we took an informal poll of nurse members of the ISPD Nursing Liaison Committee. We found that some home PD units, for example in the U.K., teach their patients to shower with the dressing in place, but then have the patient immediately after the shower remove the old dressing, perform usual exit-site care and apply a new dressing, securing the PD catheter with tape. In Australia, Brazil, Canada, Japan, New Zealand, and the U.S.A., it is more common to have the patient remove the dressing before taking a shower (but secure the PD catheter with tape), then after washing hair and body, wash around the exit site, then once out of the shower dry carefully with a clean towel and always secure the catheter again. PD catheter dressing is optional in some units when the PD Catheter exit site is well healed. ISPD does not have a specific recommendation on the topic of dressing versus no dressing. The Szeto et al. 2017 article (page 144) has detailed information from studies on topical antibiotics and antiseptics used for PD catheter exit-site care and the latest recommendations for practice (3).
Second, in response to the part of your question about cleaning the shower head, while some PD centers do recommend that patients at regular intervals use bleach to clean the shower head, we are not aware of any studies that support this practice.

1. Crabtree JH, Shrestha BM, Chow KM, Figueiredo AE, Povlsen JV, Wilkie M, Abdel-Aal A, Cullis B, Goh BL, Briggs VR, Brown EA. Creating and maintaining optimal peritoneal dialysis access in the adult patient: 2019 Update. Peritoneal Dialysis International. 2019 Sep 1;39(5):414-36. Available at: http://www.pdiconnect.com/content/39/5/414.full.pdf

2. Wallace EL, Fissell RB, Golper TA, Blake PG, Lewin AM, Oliver MJ, Quinn RR. Catheter insertion and perioperative practices within the ISPD North American research consortium. Peritoneal Dialysis International. 2016 Jul 1;36(4):382-6. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934430/pdf/pdi_36_4_006.pdf

3. Szeto CC, Li PK, Johnson DW, Bernardini J, Dong J, Figueiredo AE, Ito Y, Kazancioglu R, Moraes T, Van Esch S, Brown EA. ISPD catheter-related infection recommendations: 2017 update. Peritoneal Dialysis International. 2017 Mar 1;37(2):141-54. Available at: http://www.pdiconnect.com/content/37/2/141.full.pdf

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