On the surface of the procedure ”“ changing the sterilized pad over the surgically inserted catheter in your abdomen ”“ seems simple enough when you read about it in the literature, but there is far more to it when you attempt it at home by yourself.
My nurse instructor, Connie, supplied me with Avant gauze sponges to place over the exit site with the catheter. And, in her explanation, it was apparent that the catheter is my lifeline, a message continually reinforced in illustrated pamphlets.
As you start your scheduled training for peritoneal dialysis at home, there is the dire warning, avoid infection by constant precaution against contamination at the site of the catheter and the home surroundings. The supplies used must be obviously placed on a clean surface and easily obtained as you change the pad and check for any redness or signs of oozing.
But the first step in the care of the catheter and the exit site is your own preparation to perform the procedure. Wash your hands with soap and water for three full minutes and turn off the faucet with a paper towel and not your bare hand. Make sure your finger nails are clipped and short. Bacteria can easily remain under nails even though you meticulously attempt to clean them.
In fact, even after the three-minute wash, I was given a package of gloves to use during the change. Not only was I to wear new gloves each time, but I had a mask to wear over my nose and mouth during the process.
The original pads placed over the site during the surgery were not changed by me. The surgery took place on a Friday, and Connie changed the pads and demonstrated how to perform the disinfection of the site after I had my regular dialysis treatment on Thursday. Her instruction was clear and to the point.
First, the mask and fresh pair of gloves and then pour Povidone iodine (or Betadine solution) on a series of pads. Remove the dressing and squeeze out two pads. Clean around the exit site with a circular motion, working from the site out for five minutes. Put a new betadine pad around the exit site and tape firmly.
When you are performing the peritoneal dialysis, you will clean the catheter adapter and tubing and dry the exit site with a clean gauze pad. Another dry gauze pad is used to cover the catheter and adapter, It was reported in the literature that after your catheter is well-healed, you may not need to wear dressings.
Connie expertly performed the cleaning process after removing the pad taped to my abdomen after the surgery. There was still some healing to go through and she made sure the site was clean.
I admit I was a bit clumsy in my attempt to change pads before going to bed. The hand wash, the gloves and the wearing of the mask went reasonable well. (I played an old 78 phonograph record ”“ Bunny Berigan’s “I Can’t Get Started With You” ”“ which is three minutes) to make sure I washed my hands for the required time. Taking off the dressing wasn’t that difficult, but I was all thumbs in my attempt to clean around the site and then tape the fresh pads. It took forever it seemed to accomplish what Connie did in a matter off a minute or two.
However, on my attempt the next night, it went easier, but I forgot to roll the second pad over the first pad before taping. This flaw was discovered when Connie checked it while having my regular dialysis treatment ”“ needles in my arm ”“ on Tuesday. She had placed screens around my recliner as she checked the insertion of the catheter and then cleaned the exit site and put on fresh pads.
Connie reported that the healing process was slow and it was probably taking more time that usual because I had had two procedures during my surgery ”“ insertion of the catheter and repair of a hernia ”“ -and at 86 the body responds a trifle slower.
That was my second and admittedly timid step in the medical journey to conduct peritoneal dialysis on my own or, in lay terms, using the “kidney” I never thought I had. But I realize I have many steps to go before I reach my goal. But I have an experienced and excellent teacher/coach in Connie. Her smile and approach certainly builds your confidence in reaching that goal.
— George Douglas is the former editor of the Boston Post. He lives in Kennebunk and can be contacted via e-mail at gadoug23@earthlink.net.
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