Risk factors may include
- Contamination of the catheter during insertion, periodic changing of tubings/bags
- Skin contaminants at catheter insertion site
- Sterile peritonitis (response to the composition of dialysate)
Possibly evidenced by
- [Not applicable; presence of signs and symptoms establishes an actual diagnosis.]
Desired outcome
- Identify interventions to prevent/reduce risk of infection.
- Experience no signs/symptoms of infection.
Nursing Interventions & Rationale
| Interventions | Rationale |
| Observe meticulous aseptic techniques and wear masks during catheter insertion, dressing changes, and whenever the system is opened. Change tubings per protocol. | Prevents the introduction of organisms and airborne contamination that may cause infection. |
| Change dressings as indicated, being careful not to dislodge the catheter. Note character, color, odor, or drainage from around insertion site. | Moist environment promotes bacterial growth. Purulent drainage at insertion site suggests presence of local infection. Note: Polyurethane adhesive film (e.g., blister film) dressingshave been found to decrease amount of pressure on catheter and exit site as well as incidence of site infections. |
| Observe color and clarity of effluent. | Cloudy effluent is suggestive of peritoneal infection. |
| Apply povidone-iodine (Betadine) barrier in distal, clamped portion of catheter when intermittent dialysis therapy used. | Reduces risk of bacterial entry through catheter between dialysis treatments when catheter is disconnected from closed system |
| Investigate reports of nausea/vomiting, increased/severe abdominal pain; rebound tenderness, fever, and leukocytosis. | Signs/symptoms suggesting peritonitis, requiring prompt intervention. |
| Monitor WBC count of effluent | Presence of WBCs initially may reflect normal response to a foreign substance; however, continued/new elevation suggests developing infection. |
| Obtain specimens of blood, effluent, and/or drainage from insertion site as indicated for culture/sensitivity. | Identifies types of organism(s) present, choice of interventions |
| Monitor renal clearance/BUN, Cr | Choice and dosage of antibiotics are influenced by level of renal function. |
| Administer antibiotics systemically or in dialysate as indicated. | Treats infection, prevents sepsis |
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