MANUEL J.

SANTOS HOSPITAL
PERITONEAL DIALYSIS
PERFORMANCE CHECKLIST

EXIT SITE CARE

Name: _________________________________ Date:___________________

Check (/) the YES column if the trainee performs the activity correctly and NO if done incorrectly.

PROCEDURE YES NO REMARKS

1. Check the Physician’s order
2. Prepare materials
a) 4 sets of 4x4 sterile gauze
b) Povidone Iodine Solution
c) Normal Saline Solution
d) Medium transparent film dressing
e) Yellow plastic bag
f) Sterile gloves
g) Clean gloves
h) Sterile drape
i) Mupirocin cream
3. Perform hand hygiene.
4. Introduce self to the patient. Explain the procedure to be done.
5. Wear clean gloves
6. Partially open 4 sets 4x4 of sterile gauze (do not remove from the
package).
7. Pour liberal amount of Povidone-Iodine solution on the first set of
gauze and Saline solution on the second set of gauze.
Keep the third set of gauze dry.
8. Open the sterile drape and carefully place it on the side of the
patient’s abdomen (to maintain sterility, touch the sides of the sterile
drape only).
9. Carefully remove the old dressing on the exit site using clean
gloves. Once removed, cover the exit site with sterile gauze and ask
the patient to keep it in place.
10. Perform hand hygiene.
11. Wear sterile gloves.
12. Ask the patient to remove the gauze covering the exit site.
13. Inspect the site for any signs of infection.
14. With your non-dominant hand, lift the catheter from the
abdomen with dry sterile gauze.
15. Using your dominant hand, wipe the exit site with a Povidone-
Iodine sponge in a circular motion from inner to outer.
Repeat this procedure for three times.
16. Wipe the exit site with a saline solution sponge in a circular
motion from inner to outer. Repeat this procedure for three times.
17. Dry the area using the third set of sterile gauze.
18. Apply sufficient amount of Mupirocin cream around the exit site
using dry sterile gauze. Avoid placing Mupirocin cream on the PD
catheter.
19. Use a new set of sterile gauze to cover the exit site.
20. Secure the site with a transparent film dressing.
21. Secure the PD catheter set on the abdominal wall using a tape or
PD belt.
22. Perform after care.
23. Document findings in the chart and inform the physician if there
are signs suspicious of exit site infection.