Risk for Infection | Nursing Care Plan for Peritoneal Dialysis

Nursing diagnosis: risk for Infection

Risk factors may include
Contamination of the catheter during insertion, periodic changing of tubing and bags
Skin contaminants at catheter insertion site
Sterile peritonitis (response to the composition of dialysate)

Possibly evidenced by
(Not applicable; presence of signs and symptoms establishes an actual diagnosis)

Desired Outcomes/Evaluation Criteria—Client Will
Risk Control
Identify interventions to prevent or reduce risk of infection.
Experience no signs or symptoms of infection.

Nursing intervention with rationale:
1. Observe meticulous aseptic technique and wear masks during catheter insertion, dressing changes, and whenever the system is opened. Change tubing per protocol.
Rationale: Prevents the introduction of organisms and airborne contamination that may cause infection, the most common complication of PD.

2. Change dressings as indicated, being careful not to dislodge the catheter. Note character, color, odor, or drainage from insertion site.
Rationale: Moist environment promotes bacterial growth. Purulent drainage at insertion site suggests presence of local infection, often involving skin organisms, which can be difficult to treat and sometimes require catheter removal and temporary HD. Note: Polyurethane adhesive film (e.g., blister film) dressings have been found to decrease amount of pressure on catheter and exit site as well as incidence of site infections.

3. Observe color and clarity of effluent.
Rationale: Cloudy effluent is suggestive of peritoneal infection.

4. Apply povidone-iodine (Betadine) barrier in distal, clamped portion of catheter when intermittent dialysis therapy used.
Rationale: Reduces risk of bacterial entry through catheter between dialysis treatments when catheter is disconnected from closed system.

5. Investigate reports of nausea or vomiting, increased or severe abdominal pain, rebound tenderness, or fever.
Rationale: Signs and symptoms suggesting peritonitis, requiring prompt intervention.

6. Monitor white blood cell (WBC) count of effluent.
Rationale: Presence of WBCs initially may reflect normal response to a foreign substance; however, continued or new elevation of WBCs suggests developing infection.

7. Obtain specimens of blood, effluent, and drainage from insertion site, as indicated, for culture and sensitivity.
Rationale: Identifies types of organism(s) present and influences choice of interventions.

8. Monitor renal blood urea nitrogen (BUN) and creatinine (Cr) clearance.
Rationale: Choice and dosage of antibiotics are influenced by level of clearance.

9. Administer antibiotics systemically or in dialysate, as indicated.
Rationale: Treats infection and prevents sepsis.