PURPOSE

To prevent post operative infection at the incision and excision site.

POLICY

Pre-Operative policy

1. Patient should be admitted at least one day prior to operation. 
2. Written consent for the insertion of Tenckhoff catheter should be obtained by the attending doctor.
3. Phosphate enema should be given on the evening prior to surgery; the patient should have an empty bladder and rectum at the time of insertion to minimize the risk of organ perforation.
4. The skin should be prepared from the sternum xyphoid to mid thigh , the evening prior surgery in accordance to policy and procedure on skin preparation
5. Patient should be given Betadine scrub bath and hair shampoo on the evening prior
6. On the day of surgery patient has to take a body bath then the prepared area is patient with beta dine antiseptic and the area is draped with sterile sheet patient should wear O.T. gown.
7. A sterile aseptic technique should maintain in accordance with the policy and procedure on aseptic technique.
8. Nasal swab is taken for MRSA.
9. Coagulation profile should be ready and within normal prior to procedure.
10. Prophylactic antibiotic should prescribe by the physician.
11. As surgery is usually done under local anesthesia light sedations given on the night before the surgery.
12. If patient needs general anesthesia, the anesthesia has to prescribe per medication prior to the surgery

Post-Operative policy

1. A strict aseptic technique should be maintained throughout the procedure in accordance with the policy and procedure of aseptic technique.
   1. The dressing must be done by a physician or trained CAPD nurse.
   1. C & S swab should be taken if there any sign of infection and the physician should be informed.
   1. Mask to be warn during dressing changes to avoid contamination with oral flora.
   1. Full volume dialysis especially CAPD should be avoided for at least 10-14 days to allow hearing to occur.
   1. The exit site dressing should not be changed for 5-7 days post operatively unless there is excessive draining under the dressing.
   1. Hand washing should be performed accordingly to the policy and procedure on hand washing.
   1. The patient is rest on bed for two days after insertion of the catheter as early mobility may cause leakage. The patient should remain supine when possible and avoid activates that increase intra abdominal pressure.
   1. The patient weight is checking daily to detected edema.
   1. The bowel action is monitored daily as catheter causes pain and drainage problem.
   1. Once me pore is removed, it should be checked for any stains of discharge and note the colour.
   1. The catheter exit site is observed for discharge bleeding or over granulation of tissue, if present culture swabs are taken for C&S the physician should be informed for future management.
   1. The stitches at the incision site are removed on the seventh operative day.

EQUIPMENT

1. Trolley washed with soap and water and wiped with 70% spirit.
2. Beta dine antiseptic
3. Sterile gauze packs
4. Sterile cotton swabs
5. Dressing set
6. Clipper, Razor and scissors.
7. Tenckhoff catheter
8. Me pore 9X15
9. Surgical mask
10. Sterile gloves
11. Sterile sheet / klini drape
12. Sharp box
13. Non sterile receiver

Post Operative Care

1. Dressing of the incision site
2. Dressing of exit site (Catheter site)

Advice on Discharge

1.            When the incision has healed and exit site is clean and dry the patient is advised to clean around the catheter with soap while bathing.

2.            Immediately after bath the patient has to dry the area gently and clean with beta dine and apply me pore.

3.            Check daily for discharge and any tissue granulation

4.            The patient is advised to see the physician at the Hospital if any signs of infection are noticed. e.g.  Redness, discharge or any leakage.