The impact of exit-site care and catheter design on the incidence of catheter-related infections.

The optimal approach to catheter exit-site care and catheter design in terms of catheter-related infections (e.g., exit-site infections, peritonitis) in children remains elusive. We retrospectively compared the incidence of exit-site infections and peritonitis in 33 pediatric peritoneal dialysis patients who used one of three exit-site care/catheter combinations. The catheters used were single-cuffed, curled Tenckhoff (T), and double-cuffed Swan neck (SN). Exit-site care included either povidone-iodine (PI) or chlorhexidine (CHL) as cleansing agents. Our data suggest that the use of chlorhexidine versus povidone-iodine is associated with a significant decrease (p < 0.05) in the frequency of catheter exit-site infections in children. The use of the Swan-neck double-cuffed catheter does not appear to have any further impact on the frequency of exit-site infections. Neither the use of chlorhexidine nor Swan neck catheters had an effect on our peritonitis rate. Our review suggests that a prospective evaluation of a chlorhexidine-based exit-site care regimen in children should be encouraged.