Exit-site
infection poses a risk for
peritonitis and can shorten
peritoneal dialysis (PD) vintage. A loose fit of the skin around the
catheter at the exit site can push bacteria surrounding the
catheter into the subcutaneous tunnel.
Negative-pressure wound therapy (NPWT) has been used to hasten healing of the
wound after an operation or to treat
pressure ulcers. We hypothesized that NPWT could speed the healing of the exit site and tighten the fit of the skin around the
catheter. Using a V.A.C.
Therapy system [
vacuum-assisted closure (KCI, San Antonio, TX, U.S.A.)], NPWT was therefore applied in 9 patients for 1 - 2 weeks after the PD
catheter insertion operation. Results in those patients were compared with results in patients who did not receive NPWT.The healed exit site was classified as either tightly fitted (when the skin was tightly connected around the PD
catheter) or loosely fitted (when the skin was not tightly connected around the
catheter). The relevant data were retrieved from the medical record and analyzed retrospectively.Patients who received NPWT had a tight exit site after 1 - 2 weeks. Those who did not receive NPWT did not have a tight exit site after 1 - 2 weeks. No
bleeding was observed in patients receiving NPWT.
Bleeding from the exit site after the
catheter insertion operation was observed in 3 patients not receiving NPWT.Because we use a fine
trocar to make the subcutaneous
catheter tunnel,
bleeding from the vasculature can often be observed. That
bleeding could be minimized with the application of NPWT. Negative pressure could also hasten wound healing and result in a tight fit of the skin around the
catheter within in 1 - 2 weeks compared with the 1 month typically required with the use of conventional film dressings.Negative-pressure
wound therapy is beneficial for creating a tight fit of the skin to the
catheter within 1 - 2 weeks and might reduce the number of exit-site and tunnel
infections, which could result in a reduction in the
peritonitis rate.