Exit Site Care for Peritoneal Dialysis Catheter

It is important to take care of the skin around the peritoneal dialysis catheter. Keep it clean to prevent infection.

Patient instructions: Newly placed catheter site

 Gather your supplies:

• Clean exam gloves and 1 pack sterile gloves

• 1 sterile 2 x 2 gauze pad

• 1 sterile split 2 x 2 gauze pad

• Tegaderm™ dressing (large window version or Tegaderm IV)

• Use Sorbaview® if your child is allergic to Tegaderm.

• Chloraprep® sponge applicator (chlorhexidine gluconate antiseptic applicator). If child is allergic to Chloraprep, use:

  • Vashe® (antimicrobial wound cleanser): This bottle is good for 30 days from opening. Make sure to write the date opened on the bottle.

  • 1 package of sterile 4 x 4 gauze pads

• Masks

• Tape, Grip-Lok® Universal Securement Device (adhesive device for catheter securement) or Elastinet® (elastic net bandage)

• No Sting Barrier (liquid skin protectant) for children older than 4 weeks

• Antibiotic ointment

• Sterile cotton tipped applicator (for antibiotic ointment)

• Exit site scoring tool

Exit site care

Do this care weekly or sooner if dressing becomes wet, loose, or soiled. Continue this for 2 weeks after catheter placement or until the site is healed. Your dialysis team will tell you when your site is healed.

1. Close door to prevent the spread of infection.

2. Place supplies on a clean working surface.

3. Put on mask. 

4. Wash hands with soap and water or use hand sanitizer. Allow hands to dry.

5. Open the package of sterile gloves. Keep them sterile.

6. Use the open package of the sterile gloves as the sterile area.

7. Peel open the Tegaderm, gauze pads, split 2 x 2 gauze pad, and Chloraprep applicator. Drop on sterile area. Open the antibiotic ointment and squeeze a small amount on the part of the sterile area to the side of the gloves. Peel open the sterile cotton tipped applicator. Drop onto middle of sterile area.

8. If any of these supplies become contaminated (not sterile) throw away and get new supplies.

9. If using Vashe instead of Chloraprep, open sterile package of 4 x 4 gauze. Leave inside of the package.

10. Open the bottle of Vashe and soak the 4x4 gauze.

11. Perform hand hygiene and put on clean exam gloves.

12. Remove the dressing and gauze pads. Check for signs of infection using the exit site-scoring tool. If there are signs of infection or the score is greater than 2, call the nephrology fellow or PD nurse.

13. Remove exam gloves. Wash your hands or use hand sanitizer. Allow hands to dry.

14. Put on sterile gloves as taught. You can only touch the supplies in the glove wrapper.

15. Pick up the Chloraprep applicator. Hold applicator with sponge facing downward and squeeze the wings to release the solution.

16. Press sponge onto the exit site. Scrub with the sponge using a back-and-forth motion for 30 seconds. Scrub the area about 2 inches around the exit site.

17.  Allow Chloraprep solution to dry.

18.  If using Vashe in place of the Chloraprep, take the gauze with Vashe solution, gather the four corners of the gauze, and scrub with the gauze using a back-and-forth motion for 30 seconds. Scrub the area about 2 inches around the exit site. Let dry.

19.  If your child is more than 4 weeks old, apply No Sting Barrier to the area of the dressing. Do not apply to catheter exit site. (This is optional)

20. Apply antibiotic ointment to catheter exit site using sterile cotton tipped applicator.

21. Place sterile 2 x 2 split gauze pads around catheter.

22. Cover split gauze pad with sterile 2 x 2 gauze pad.

23. Cover gauze with the Tegaderm or Sorbaview dressing. Mold dressing along catheter to secure. Mepilex®. Border dressing may be used in place of Tegaderm for skin sensitivity to Tegaderm or Sorbaview®.

24. Secure the catheter using tape, Grip-Lok Universal Securement Device or Elastinet to prevent pulling.

Patient instructions: Healed sites

Perform this care once daily or sooner if dressing becomes wet, soiled or not intact, once your dialysis team tells you that the exit site is healed.

Gather your supplies

• Chloraprep sponge applicator (chlorhexidine gluconate antiseptic applicator). If child is allergic to Chloraprep, use:

  • Vashe (antimicrobial wound cleanser) 

  • 1 package of sterile 4 x 4 gauze pads

• Tape, Grip-Lok Universal Securement Device (adhesive device for catheter securement) or Elastinet (elastic net bandage)

• No Sting Barrier (liquid skin protectant) for children older than 4 weeks

• 1 sterile 2 x 2 split sponge

• 1 sterile 2 x 2 gauze pads

• Tegaderm dressing, Sorbaview, or Mepilex® Border dressing (soft silicone foam dressing) for sensitive skin

• Clean exam gloves

• Masks

• Antibiotic ointment

• Sterile cotton tipped applicator (for antibiotic ointment)

• Exit site scoring tool

Exit site care

1. Close door to prevent the spread of infection.

2. Gather supplies and place on clean working surface.

3. Wash hands or use hand sanitizer. Allow hands to dry.

4. Open supply packages, leaving items inside of their packages to keep them clean or aseptic.

5. If using Vashe instead of Chloraprep, open sterile package of 4 x 4 gauze. Leave inside of the package.

6.  Open the bottle of Vashe and soak the 4x4 gauze.

7.  Put on mask.

8. Perform hand hygiene and put on clean exam gloves.

9. Remove old dressing.

10. Remove gloves. Wash hands or use hand sanitizer. Allow hands to dry.

11. Put on a new pair of exam gloves.

12. Starting at exit site with Chloraprep applicator, press sponge onto the exit site. Scrub with the sponge using a back-and-forth motion for 30 seconds. Scrub the area about 2 inches around the exit site. Allow Chloraprep solution to dry.

13.  If using Vashe in place of the Chloraprep, take the gauze with Vashe solution, gather the four corners of the gauze, and scrub with the gauze using a back-and-forth motion for 30 seconds. Scrub the area about 2 inches around the exit site. Let dry.

14. Check for signs of infection using the exit site-scoring tool. If there are signs of infection or your score is greater than 2, call the nephrology fellow or PD Nurse.

15. If child is more than 4 weeks old, apply No Sting Barrier to the area of the dressing. Do not apply to catheter exit site. (This is optional)

16.  Apply antibiotic ointment to the catheter exit site using sterile cotton tipped applicator.

17. Place sterile 2 x 2 split gauze pad around catheter.

18. Cover split gauze pad with sterile 2 x 2 gauze pad.

19. Cover gauze with the Tegaderm or Sorbaview dressing. Mold dressing along catheter to secure. Mepilex Border dressing may be used in place of Tegaderm for skin sensitivity to Tegaderm or Sorbaview.

20. 21. Secure the catheter using tape, Secure the catheter using tape, Grip-Lok Universal Securement Device or Elastinet to prevent pulling.

Peritoneal Dialysis (PD) Catheter Exit Site Scoring Tool

During dressing changes, use the scoring tool below to check the exit site.

• Record the exit site score on the home flowsheet provided by the dialysis nurse each time you change the dressing.

• If your child has a total exit site score of 4 or more, they need to be treated for an infection. Please notify your dialysis team right away.

Example: If your child has a little swelling and crusting (both less than 0.5 cm), they would receive a score of 2—1 point for each finding. This can be normal, especially before the exit site is fully healed.

For each category below, choose the description that best matches the exit site’s condition. Note the score at the end of each option and add up all points at the end for the total score.

Swelling

• No swelling – 0 points

• Swelling at the exit only (less than 0.5 cm) – 1 point

• Swelling includes part of or the entire tunnel (greater than 0.5 cm) – 2 points

Crusting

• No crust – 0 points

• Crust smaller than 0.5 cm – 1 point

• Crust larger than 0.5 cm – 2 points

Redness

• No redness – 0 points

• Redness smaller than 0.5 cm – 1 point

• Redness larger than 0.5 cm – 2 points

Pain on Pressure

• No pain – 0 points

• Slight pain – 1 point

• Severe pain – 2 points

Drainage

• No drainage – 0 points

• Clear (serous) drainage – 1 point

• Thick, cloudy (purulent) drainage – 2 points

Contact your CHOP dialysis team with questions or concerns.

• 8:30 a.m.-4:30 p.m., Monday-Friday call 215-590-2449.

• Outside of those hours, and on holidays, call 215-590-1000, ask the hospital operator for the nephrology fellow or PD dialysis RN.

Reviewed March 2026 by Alexandra Pietrzyk BSN, RN