There are several benefits of peritoneal dialysis as a treatment modality; like home-based care, greater flexibility, needle-free and so on. However, patients must be compliant to infection control measures to reduce the risk of peritonitis or exit site infection. Peritonitis (infection of the peritoneum) is a leading cause of PD technique failure (i.e. patients can no longer continue on peritoneal dialysis). As such, much of the training and education is based around excellent hand hygiene and wound dressing techniques.
Minor inconveniences caused by a catheter protruding out of your abdomen, like tight-fitting pants that rub against the catheter or its surrounding dressing gauze, are a common occurrence. But have you thought about patients who enjoy swimming? Is peritoneal dialysis a no-go for them?
On a daily basis, patients on PD have to waterproof their exit site prior to bathing. If and when the dressing is soiled or wet, it has to be changed right away. A recent survey of 39 nurses from different Australian PD units reported that 70% of the units permitted swimming (1). Some sites reported up to 40% of their patients swim. Another study with over 300 Austrian patients reported that 90% (21 out of 23) PD centres allowed swimming among their patients (2). Most sites recommended only swimming in sea water or private highly-chlorinated swimming pools. The International Society for Peritoneal Dialysis (ISPD) who sets out guidelines for PD patients and clinicians stated that there has not been sufficient data to provide any evidence-based practice recommendations to disallow swimming (3). Multiple interviewees from the Australian study also stated the duration and timing of the swim; swimming less than an hour, in the morning and not after a storm, was part of the advice they gave to patients. Most patients chose to don a waterproof dressing or a colostomy bag prior to swimming.
Ultimately, it comes down to maintaining the cleanliness of the exit site and catheter at all times. Patients who go onto PD are encouraged to maintain their lifestyle to the period prior to going on PD as much as possible. Thus it seems like, if good hygiene practices are followed, swimming could be a good and gentle form of exercise for PD patients. So, is swimming with a PD catheter a go or no go for you?
1. Lee A: Swimming on peritoneal dialysis: Recommendations from Australian PD units. Perit Dial Int 39: 527–31, 2019
2. Kopriva-Alfarht G, Konig P, Mundle M, Prischl F, Roob J, Wiesholzer M: Exit-site care in Austrian Peritoneal dialysis centers- A nationwide study. Perit Dial Int 29: 330–9, 2009
3. Szeto C, Li P, Johnson D, Bernardini J, Dong J, Figueiredo A, Ito Y, Kazancioglu R, Moraes T, Van Esch S, Brown E: ISPD catheter-related infection recommendations: 2017 update. Perit Dial Int 37: 141–54, 2017
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