Answer: The first key to success with your catheter is that the surgeon or nephrologist placed it properly. The exit site should be away from sites of trauma such as a belt line or other tight-fitting clothing. The exit site should face either downward or laterally, not upward, so that it can drain away from the tunnel and so that sweat does not drain into it.

The catheter itself should be anchored in such a way that it does not wiggle at the exit site and so that exchanges do not traumatize the flesh when the catheter's external portion is handled. There are many forms of anchors, from tape to adhesives to elastic mesh supports. The exit site care varies from daily soap and water washing to antibiotic ointments. This should be taught during training. Whatever is prescribed for exit site care, it is extremely important that it be followed on a daily basis. Once an exit site is traumatized or infected, it may not be easy to cure. Therefore, initial attention must be directed towards preventing this problem.

The part of the catheter that is internal can also be cared for indirectly. Constipation is the most frequent cause of catheter dysfunction. Some people are used to infrequent bowel movements and seem to tolerate this. The peritoneal dialysis itself is constipating. However, physical activity such as walking and diets high in fiber are conducive to frequent and regular bowel movements. A daily bowel movement is preferred, regardless of an individual's acceptance of less frequent movements. Laxatives will usually correct the most frequent catheter dysfunctions caused by constipation.

Answer provided by Tom Golper, MD. Dr. Golper is a Professor of Medicine at the Vanderbilt University Medical Center, Division of Nephrology and a member of the AAKP Board of Directors. He is also a member of the AAKP Medical Advisory Board.

The Dear Doctor column provides readers with an opportunity to submit renal related health questions to healthcare professionals who specialize in the area of concern. The answers are not to be construed as a diagnosis and therefore, altercations in current healthcare should not occur until the patient's physician is consulted.

This article originally appeared in July 2001 aakpRENALIFE, Vol. 17, No. 1.

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