Hi, I have a patient with severe intellectual impairment who has ESRF and embarking on RRT. Swimming is enjoyable activity for this young man . His mum will be doing his dialysis and thought of doing HD is very overwhelming for mum. I wanted to know what are the recommendations around swimming and PD, once the exit site has healed. he will be swimming in both public and private pools. Is it an absolute contraindication? Can it be pursued with use of colostomy bags and meticulous exit site cares. Thanks for letting me know. Reshma
Hi, I have a patient with severe intellectual impairment who has ESRF and embarking on RRT. Swimming is enjoyable activity for this young man . His mum will be doing his dialysis and thought of doing HD is very overwhelming for mum. I wanted to know what are the recommendations around swimming and PD, once the exit site has healed. he will be swimming in both public and private pools. Is it an absolute contraindication? Can it be pursued with use of colostomy bags and meticulous exit site cares. Thanks for letting me know. Reshma
Posted in

Questions About PD

Vote Up
0
Vote Down
open
Reshma Shettigar, Doctor/MD from New Zealand asked
Hi, I have a patient with severe intellectual impairment who has ESRF and embarking on RRT. Swimming is enjoyable activity for this young man . His mum will be doing his dialysis and thought of doing HD is very overwhelming for mum. I wanted to know what are the recommendations around swimming and PD, once the exit site has healed. he will be swimming in both public and private pools. Is it an absolute contraindication? Can it be pursued with use of colostomy bags and meticulous exit site cares. Thanks for letting me know. Reshma

2 answers

Vote Up
0
Vote Down
Public
⋅ ⋅ August 22, 2021

HI
Swimming is not contraindicated in PD, however the exit site care must be given extra attention after the activities. The exit site must be dry post swimming to prevent possibility of ESI. Colostomy bag can be use to contain the PD catheter. However, if swimming cause exit site infection recurrently for this patient, it is advisable not to pursue it anymore. The care must be a shared decision and the parents must always be aware of the possible risks. 
Fadhlina
Malaysia

#1
Vote Up
0
Vote Down
Public
⋅ Nurse Canada with members of the ISPD Nursing Liaison Committee ⋅ August 24, 2021

We thank you for your question. We agree with the response above and would like to add that there is, indeed, limited information on this topic. A recent survey of nurses from 39 home PD units in Australia published in Peritoneal Dialysis International found that, in general:
“Almost all units reported that patients on PD do swim despite only 77% of units advocating swimming. Swimming in sea water (85%) or a private swimming pool (90%) is mostly recommended. Covering the exit site and PD catheter is recommended with a waterproof film dressing or colostomy bag. Performing routine exit-site care after swimming is recommended (100%). There were 7 reported exit-site infections and 2 episodes of peritonitis perceived to be associated with swimming with a PD catheter” (1).
 
The authors of much earlier published guidelines for pediatric patients on PD make the following recommendation:
“Swimming is not encouraged, especially in public pools, lakes or rivers, and whirlpools or hot tubs. It can take place with good supervision and with occlusive dressings covering the exit site and catheter after the 6-week healing period. An immediate dressing change should take place after swimming” (2).
 

  1. Lee A. Swimming on peritoneal dialysis: recommendations from Australian PD units. Peritoneal Dialysis International. 2019 Nov;39(6):527-31.

    2. Watson AR, Gartland C, European Paediatric Peritoneal Dialysis Working Group. Guidelines by an ad hoc European committee for elective chronic peritoneal dialysis in pediatric patients. Peritoneal dialysis international. 2001 May;21(3):240-4.

#2

Please login to submit an answer