Patients on peritoneal dialysis use the lining of the belly to filter blood, and bacteria can enter through the catheter, often after a break in sterile technique. The infection causes cloudy dialysis fluid and pain and must be treated quickly to save the catheter and the dialysis method.
Key symptoms
- Cloudy dialysis fluid when draining
- Diffuse abdominal pain and tenderness
- Fever, nausea and vomiting
- Poor drainage or less fluid removed
What you find on exam
- Abdominal tenderness and rebound
- Catheter exit site and tunnel for redness, crusting or pus
- Temperature, heart rate and blood pressure
- Fluid status: edema, weight and lungs
Tests
- Effluent cell count: white cells above 100 per microliter with over 50% neutrophils
- Gram stain and culture of the effluent in blood culture bottles
- Blood count, electrolytes and blood cultures if septic
- Exit site swab if there is discharge
Treatment basics
- Start intraperitoneal antibiotics right away, such as vancomycin plus ceftazidime
- Adjust to culture results and treat for 2 to 3 weeks
- Add heparin to the bags if fibrin is seen
- Retrain the patient on hand hygiene and exchange technique
- Remove the catheter for fungal or refractory infection
Red flags
- Low blood pressure or signs of sepsis
- No improvement after 5 days of antibiotics
- Several organisms in culture suggesting a bowel perforation
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Sources: NCCPA PANCE Content Blueprint; NCSBN 2026 NCLEX-RN Test Plan; CDC, Hand Hygiene in Healthcare Settings. Written by Making Synapses. Making Synapses is not affiliated with these organizations.