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I feel irritation of the skin at the exit site for dialysis, what do I do?

Q: I am a 65 years old CAPD dialysis patient. I do dressing daily on my exit site but I am suffering from irritation of the skin around the exit site (but there is no infection) due to adhesive tapes used to cover gauze. Can I do daily dressing by applying betadine lotion and bactroban ointment but not cover the exit site by gauze and adhesive tapes? I feel pain on the skin around the exit site because of the tape and after taking Ultracet, I feel relieved. What should I do?

A:If the exit site is completely healed, it would not be necessary to wear a dressing around the exit site but it would still be important to clean the surface around the catheter every day with the soap and water and to apply betadine. As far as wearing a dressing over the exit site is concerned, there is no clear data that proves that having a dressing over a healthy healed exit site would prevent any infection. But it should be worn if the exit site is likely to get dirty/soiled or wet. Besides, it would help secure the catheter in place. The exit site should be washed daily or every other day with an antibacterial solution or an antiseptic ointment (povidione iodine or chlorhexidine). Regular use of antimicrobial solutions (e.g., ciprofloxacin) and ointments, such as mupiricin and gentamicin, have been shown to decrease the incidence of infection. Though it would be practical for you to avoid the dressing cover over the exit site for most of the day for some time just to get relief from the allergic reaction to the mentioned adhesive tapes, it would still be advisable for you to use a adhesive dressing to which you would not be allergic, over the exit site in the long term basis primarily to secure the catheter and protect the exit site from getting soiled.

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