Mr Jadon Ryan Yang1, Ms MARIA DARAOAY2, Associate Professor LUKAS KAIRAITIS1,2, Dr JOHN WING LI1,2, Associate Professor KAMAL SUD3,4, Dr KATRINA CHAU1,2
1School of Medicine, Western Sydney University, Campbelltown, Australia, 2Regional Dialysis Centre, Blacktown Hospital, Blacktown, Australia, 3Nepean Kidney Research Centre, Department of Renal Medicine, Kingswood, Australia, 4Nepean Clinical School, Faculty of Medicine & Health, University of Sydney, Kingswood, Australia
Biography:
Jadon is a 5th year medical student at Western Sydney University who has a special interest in nephrology.
Aim:
To identify the barriers and reasons for non-adherence to exit-site care in patients on peritoneal dialysis (PD).
Background:
Catheter-related infections (CRIs) can lead to severe complications such as peritonitis and catheter removal. Adherence to exit-site care instructions remains variable. The underlying reasons and barriers for non-adherence are poorly understood.
Methods:
A cross-sectional survey was conducted among prevalent patients on PD at Western Renal Services (Sydney, Australia) during routine clinic visits. Participants provided information on training, exit-site care practices, adherence barriers and reasons for non-compliance. Clinical data on CRIs and peritonitis were retrieved from electronic medical records. Responses were categorised and analysed using descriptive statistics.
Results:
Fifty-six patients on PD were surveyed, with 28 (50%) reporting variations from initial training instructions. Seventy percent were male, with English (n=23, 41%) and Tagalog (n=8, 14%) being the most commonly spoken languages. Exit-site care was self-performed in 37 patients, while 19 had carer involvement; the self-care group had higher rates of CRIs (p=0.02). Cleaning frequency was the most commonly neglected aspect of care (n=13), ranging from 2 to 6 days per week among non-adherent patients. Common reasons for non-adherence included adverse reactions to cleaning materials (n=13), perceiving care as unnecessary (n=10), and lack of motivation (n=8). Barriers included cost (n=3) and lack of supplies (n=2), but most non-adherent patients did not report any barriers (n=21). Medihoney was the antiseptic most frequently associated with adverse reactions (n=12).
Conclusions:
Non-adherence to exit-site care was driven by perceived necessity, patient motivation, and adverse reactions, particularly to Medihoney. Practical barriers including cost and supply issues also played a role. Carer involvement was associated with lower CRI rates.