Exit site made

wounds easy
Volume 3 | Issue 2 | June 2012 www.woundsinternational.com

Box 1 Risk of complications in exit site wounds

Introduction Q Central venous catheters are responsible for an estimated
250,000-400,000 bloodstream infections per year worldwide,
Crude tracheotomies have been depicted on with an associated mortality of 10-35%4
Egyptian artefacts as far back as 3600BC1, while the Q Exit site infections in peritoneal dialysis result in a six-fold

ancient Syrians used catheters fashioned from reeds. increased risk for peritonitis, leading to catheter removal in
50% of cases5
Percutaneous devices are now in common use in Q Pin tract infection is a major complication of external
clinical practice over a wide range of therapy areas. fixation for complex fractures and limb deformity2. Reported
infection rates around the pin site range between 1% for major
These devices create a wound (exit site) that needs to infections (eg osteomyelitis) and 80% for minor infections6
be managed appropriately to prevent complications, QPercutaneous endoscopic gastrostomy (PEG) is the method of

such as infection or overgranulation. Effective choice for long-term artificial enteral nutrition/hydration. Local
infection occurs in approximately 2% to 39% of procedures7
management of an exit site wound can be challenging,
although the risks can be reduced by adopting
principles of good basic care, close observation and The length of time that a percutaneous or external fixation device
appropriate patient and carer education. is in place will depend on the therapy area or treatment required.
The longer a patient has an exit site wound, the greater the chance
of developing complications2. For example, an orthopaedic pin
Authors: Spruce P, Warriner L, Keast D, Kennedy A. Full or wire will be required until the fracture is healed when it can be
author details can be found on page 6. removed. However, a patient who cannot eat or drink may require
nutritional support via a PEG for the remainder of his/her life.

What is an exit site wound?

A range of percutaneous devices are currently used in clinical Why are exit site wounds challenging?
practice, including peritoneal dialysis (PD) catheters, percutaneous Exit site wounds are at increased risk of infection and patients who
endoscopic gastrostomy tubes (PEGs), tracheostomy tubes, require these devices may also have associated comorbidities that
suprapubic catheters, and vascular access devices. These devices put them at higher risk of wound complications. It is important
are indicated for patients who are unable to maintain normal bodily that a holistic approach is adopted to maintain the patency of the
functions as a result of illness or disability and require additional exit site for as long as possible and to prevent complications. Each
therapy to maintain life. device has specific requirements for its management. A poorly
managed exit site wound can increase the risk of complications,
Percutaneous devices are introduced through a surgically created which can result in a reduced quality of life, death or discontinuation
defect in the skin to provide access to underlying structures, organs of the therapy (Box 1).
or tissues for the administration or removal of fluids or gases. This
opening in the skin is known as the exit site: in some specialties and/
or countries this is also referred to as an entry or insertion site. Developing best practice
Best practice guidelines that focus on the management of
In addition, external fixation devices, which hold skeletal wires or pins acute and chronic wounds may be inappropriate for exit site
in place may be used as part of a trauma or orthopaedic treatment management. Further work is needed to develop guidance for
care plan. A percutaneous wound is formed at the interface between clinicians on exit site management, based on current evidence
a pin or wire and the skin — this also known as a ‘pin site’2. and best practice.

Unlike acute or chronic wounds where the ultimate goal is

wound healing, for an exit site wound the aim is to maintain Basic principles for exit site wound
a healthy opening with minimal exudate. While there is a management
natural tendency for the wound to close around the tube3, all Each device will have specific requirements for its ongoing
percutaneous devices and external fixator pins or wires act as management and it is important that the manufacturer’s instructions
a foreign body in the tissue, preventing closure of the wound. and local protocols are followed. While these may be incorporated
Healing can only occur once the device has been removed at into clinical guidelines, there are a number of basic principles that are
the end of treatment. relevant to all exit site wounds.

1
 Exit site made
wounds easy
Basic management principles include: damage to the device, or there is no risk of it the bacterial load. For therapies where
Q Ensuring the patency and liquefying with leakage down the opening of this approach is used, a daily routine
effectiveness of the device the exit site. of cleansing is often recommended,
Q Maintaining the integrity of the although the frequency may be altered
surrounding skin Preventing exit site infection based on the condition of the wound,
Q Preventing infection and other All exit sites are colonised with bacteria; level of exudate and the lead clinician’s
complications. heavy bacterial colonisation can lead to exit recommendations.
site infections. Common pathogens include
Effective management of the Staphylococcus aureus, including MRSA, Establishing a routine of regular cleansing
device Pseudomonas aeruginosa and Escherichia can help the patient or carer to observe
The risk of complications developing in coli. Fungal infections are often problematic the site and recognise any early onset
and around an exit site will depend on the where devices are made of polyurethane of complications. This involves a simple
general condition of the patient and the or silastic, such as those used in PEGs and three-step method:
type of device used. This risk can be reduced suprapubic catheters11. 1. Cleanse the skin around the device
using good basic care, close observation and using a mild soap and warm water
appropriate education to ensure that the Infection may be superficial around 2. Cleanse the device according to the
device is managed correctly. the exit site or it may progress down manufacturer’s instructions, removing
the tract or tunnel, increasing the risk any build up of dried exudate or blood
All devices need be positioned, of bacterial invasion of the underlying and residual soap
immobilised and secured properly8,9. structures. This may be a particular 3. Dry the area thoroughly using a clean
This may involve the use of appropriate issue if the device becomes loose or is cloth.
dressings to help immobilise the positioned incorrectly.
device 2. Patient movement or poor During any cleansing procedure, care
positioning, however, may cause the Wound cleansing using an should be taken to prevent fluid leaking
device to damage the surrounding skin aseptic approach into the tube. Ideally, the exit site and
by pressure or friction. Where dressings For some devices, such as central lines or device should be thoroughly dried
or tapes are required, these should not percutaneous intravenous central catheters using a suitable cloth. Fabrics, such as
cause any additional trauma to the site (PICCs), an aseptic technique12 is used for gauze, may shed fibres onto the exit
and should be replaced when they the duration of therapy, followed by the site and should be avoided as these can
become wet or soiled to reduce the risk application of a clear film dressing to allow increase the risk of further irritation and
of infection10. observation of the exit site. This procedure inflammation.
should be repeated weekly13, but if infection
Devices should also be checked to ensure is suspected the exit site should be cleaned Other general advice includes:
they fit properly and there is no splitting more frequently2. Q Patients should take a shower rather

or cracking, which may allow fluid to leak than have a bath, although this
onto the surrounding skin. Inspection can The aim of cleaning the wound is to will vary according to the device.
be undertaken during routine cleansing. reduce the number of micro-organisms Showering may be recommended
present and to remove exudate, blood immediately prior to dressing changes
Maintaining skin integrity and wound debris from around the or on the day of dressing changes2
The skin surrounding the exit site should site and the device, which may be a Q Patients should be advised that shower

be kept clean and dry to prevent bacterial medium for bacterial growth14. Normal gel or shampoo could cause an exit site
growth. In the immediate postoperative saline and antiseptic agents such as reaction16.
period, a clinically clean, undisturbed povidone iodine, chlorhexidine and
environment is often recommended to polyhexamethylene biguanide (PHMB) Role of dressings
promote epithelialisation of the sinus tract8,9. are commonly used6,15. Dressings may be used to provide an
effective barrier to prevent bacteria and
The use of a barrier cream is not routinely Wound cleansing using a socially other contaminants from entering the
indicated for the management of the skin clean approach exit site wound. Guidance on the use of
surrounding an exit site. If this is required to For some exit wounds a ‘socially clean’ dressings tends to focus on their use and
treat skin irritation or excoriation, the clinician approach may be used to keep the site advantages, rather than recommending
must ensure that the product will not cause free from contaminants and reduce one product over another. For example,

2
a recent consensus on pin site management found that most How to treat exit site infection
respondents (76%) agreed that wounds should be dressed, Early identification and diagnosis of infection is important for
but there was a lack of agreement as to what type of dressing prompt and effective treatment. Each therapy area will have specific
should be used. There was strong agreement that the dressing guidelines for the detection and management of infection, which
material should keep excess moisture away from the wound will depend on observation of the patient, possible microbiological
(86.7%) and that dressings should be kept clean and dry and be cultures and the use of an appropriate treatment (eg systemic
changed weekly or more frequently for infected wounds2. There antibiotics) when indicated.
has been an increase in the use of dressings impregnated with
antiseptic agents in exit site management. In a recent review, The use of dressings impregnated with antiseptic agents such as
Hadaway reported on the use of PHMB to reduce surgical site silver, iodine, PHMB, chlorhexidine and honey may be used for
infection (SSI)17. As the same organisms found in SSI are also their barrier function where localised infection is suspected. A
found in catheter-related bloodstream infections, the author small randomised controlled study using PHMB-impregnated
suggests that PHMB could be of benefit when used for this type dressings has demonstrated a reduction in the rate of
of wound. methicillin-resistant Staphylococcus aureus (MRSA) colonisation
around tracheostomy sites20, while a small non-comparative
evaluation of a silver dressing was found to be effective in
Infection as a complication around reducing MRSA around PEG sites21.
exit site wounds
The risk of infection should always be considered and it is A range of antimicrobial dressings is now available that has
important to recognise the risk factors associated with the been specially designed for use around exit sites and include
different devices and therapies. It is recommended that a fenestrated, keyhole or disc-shaped dressings (eg KendallTM AMD
comprehensive assessment of the patient and his/her wound antimicrobial foam dressings) (Figure 1). Alternatively, suitable
should be undertaken to identify the risks and appropriate steps antimicrobial dressings can be cut to fit around the device.
taken to reduce infection. The frequency of review will depend
on whether the device is for short-term or permanent use. Biofilms and exit sites
A biofilm develops when free floating micro-organisms attach to a
What are the associated risk factors? surface, quickly replicating and forming colonies that are tolerant to
There are a number of risk factors that can increase the risk of infection antibiotics, antiseptics and disinfectants22.
at the exit site. These may be related to:
Q The general condition of the patient and host factors, such as Biofilm formation is a specific risk on percutaneous devices, in
comorbidities (eg diabetes, anaemia and malnutrition), as well particular, tubular latex or silicone devices, which when inserted
as lifestyle choices such as smoking may acquire biofilms on the inner or outer surfaces11. The longer
Q The use of medications that impair wound healing, such as the device remains in place, the greater the tendency of these
steroids or cytotoxic agents organisms to develop biofilms and they are now recognised as
Q Whether the procedure was planned and the use of antibiotic a major factor contributing to bacterial infection and chronic
prophylaxis at the time of insertion. inflammation. However, the link between biofilm contamination
and the development of infection is not yet understood11.
Identifying exit site infection
Following the introduction of the device, it is normal for the signs While the presence of a biofilm on a device does not
of inflammation (eg heat, bloody or yellowish discharge, pain and represent a clinical infection, it can lead to replacement or
erythema) to develop around the exit site, but these signs should removal of the device.
subside within 72 hours18,19. This is a normal response and should not be
mistaken for infection. Management of biofilms and exit sites
A number of general wound management measures can be used to
The signs and symptoms of infection include pain, increased exudate, disrupt biofilm formation, including the use of an aseptic technique to
heat and erythema. The opening tract may become enlarged or there prevent nosocomial or cross-infection at the site.
may be signs of tissue breakdown3 and the patient may present with
pyrexia. A serous (blood stained) or purulent discharge indicates the It is recommended that cleansing with saline or antiseptic agents
presence of bacteria and the possible development of an abscess together with an appropriate debridement technique should be used
or tunnel infection. Ultrasonography or other investigations (eg to disrupt the biofilm23. However, eradication is difficult due to the
microbiology) may be undertaken to confirm this. tolerance of biofilm organisms on these devices24.

3
Figure 1: The Kendall™ AMD antimicrobial foam disc can Figure 2: Overgranulation in a four-year-old boy with Figure 3: Exophytic hypergranulation tissue around PEG
be used around percutaneous devices for the protection a low profile device. Note evidence of fresh bleeding site of 12-month-old baby (courtesy of A Kennedy).
and management of the exit site (photo courtesy of G and excessive granulation tissue causing poor fitting of
Totten, Renal Unit, Antrim, NI). gastrostomy button (courtesy of A Kennedy).

Some devices can deter biofilm formation, fluid leakage leading to skin breakdown may be overlooked by the patient as it is
either because they are impregnated may also be a contributory factor33 generally painless. It may present as:
with antimicrobial agents or the material (Figures 2-6). Q ‘Healthy’ overgranulation —a pinky

surface can reduce adherence of micro- red moist cauliflower-like structure35,

organisms25,26. The development of overgranulation which may bleed but is otherwise
tissue can cause increased exudation, symptom free34.
which may lead to maceration of Q ‘Unhealthy’ overgranulation tissue — a

Overgranulation as a the surrounding skin and soiled beefy red or bluish mass that extends
complication around exit clothing34. When associated with above the wound surface and may be
site wounds an increased bacterial load, this dehydrated, friable and easy to break27.
The development of overgranulation may cause the wound to become
(hypergranulation) tissue around an exit malodorous. This, together with It is important that overgranulation
site is relatively common, although why this bleeding and increased exudate, can tissue is detected at an early stage, so
occurs is not fully understood. In chronic impact negatively on the patient’s that treatment can be implemented
wounds, it is thought that this may be due to quality of life26 and it is important before further complications develop
prolonged inflammation27,28, external friction that the underlying cause is identified around the exit site. As many exit sites are
or continued minor trauma29,30, and overuse and corrected. If undetected or routinely managed by patients and their
or inappropriate use of occlusive dressings31. left untreated, there is the risk that carers, they should be given appropriate
overgranulation tissue may lead to information and visual aids to recognise
For exit sites, overgranulation is thought replacement of the device or removal. this complication.
to develop as a result of constant friction
between the device and the skin, caused How to identify How to manage
by a poorly fitting or inappropriately overgranulation? overgranulation?
secured device32. Excess moisture from The development of overgranulation tissue The prevention of overgranulation relies on

Figure 4: A healthy PEG site (photo courtesy of L Warriner). Figure 5: Overgranulation tissue around a PEG site Figure 6: Excoriation around a PEG site (photo courtesy
(photo courtesy of L Warriner). of L Warriner).

4
regular and systematic care of the exit site. Foam dressings
This involves cleansing the surrounding skin Foam dressings are increasingly being
and the device to prevent infection and skin used as an atraumatic method of reducing
maceration. overgranulation. When applied to the
wound the dressing provides localised
It is recommended that the exit site be pressure, which may help to reduce the
checked by the patient or carer on a daily oedema and flatten the affected tissue27.
basis, although this may be carried out more It has been suggested that two pieces
frequently if complications are detected. of the foam may be used to increase the
pressure32.
Figure 7: Neonate with a fungal rash and
There is a lack of good quality evidence of
hypergranulation treated with topical silver nitrate
the best way to manage overgranulation by an untrained, inexperienced practitioner (photo A recent independent audit of 24 patients
and options may depend on product courtesy of A Kennedy). with overgranulation tissue around the
awareness, availability and local exit site evaluated a standard approach to
protocols. The clinician should consider chemical burns and to manage the treatment involving:
the effectiveness of the intervention, increased exudate associated with this Q A daily routine of cleansing the exit

how comfortable it is for the patient, technique35. However, this method site and checking the device.
and the risk to the device and the is now discouraged when used by Q Daily dressing changes using a

surrounding tissues. clinicians without the appropriate level PHMB- impregnated foam dressing
of skill and knowledge as it can cause (KendallTM AMD antimicrobial foam
Goals of treatment trauma to the wound and increased dressing). This should be cut to a
The goal is to manage the associated inflammation27 (Figure 7). keyhole shape and fitted around the
excess exudate and bacterial burden, device, and covered with a standard
and apply sufficient gentle pressure to Topical steroids polyurethane foam dressing.
reduce the overgranulation tissue33. If Topical steroids can be applied to reduce Q Review at two weeks and then every

the cause of the overgranulation is due the inflammatory response26, but must two weeks for six weeks.
to inflammation then consider securing be used with caution in devices where
the device to minimise friction around there is the risk of fungal infection. Topical The results of the audit found that
the wound site32. steriods should be applied according to the after using the PHMB impregnated
manufacturer’s instructions and may need foam dressing and standard foam for
Physical and chemical removal to be covered with a foam or non-adherent two weeks, there was resolution of the
Overgranulation tissue may be removed dressing. overgranulation tissue in 33% of patients.
by surgical debridement or curettage. There was complete resolution of
This is a one-off procedure and requires a Haelan® Tape (Typharm) is a transparent overgranulation at the six week review in a
high level of clinical expertise and should surgical tape, which has been total of 16/24 patients (66.6%)33.
only be performed by a specialist who has impregnated with a low dose of steroid
been trained appropriately36. It is usually and is marketed specifically for the
undertaken in the operating theatre and treatment of overgranulation. It has The role of education
may be painful for the patient. the advantage of exerting pressure to It is important that clinicians keep-up-
reduce the overgranulation and can be to date with current technologies and
Silver nitrate treatment is a cut to shape around the site26,32. procedures to ensure the best care for their
longstanding treatment of patients9. Many patients with long-term
overgranulation tissue26. It can be Antimicrobial dressings devices are encouraged to self-manage
applied using a stick with the tip Topical antimicrobial dressings can be used at home. Healthcare professionals should
consisting of 95% silver nitrate to reduce the bioburden in the tissue and provide adequate support for patients to
and 5% potassium. It has been subsequent inflammatory response. The use manage their device appropriately and
shown to be effective when used of polyhexamethylene biguanide (PHMB) help prevent complications. It is important
daily or twice daily for up to four is relatively new in this indication but is that patients are concordant with the care
days37. The surrounding skin may effective against a range of bacteria and of the device and the surrounding tissues.
require protection with a simple fungi38 and is not deactivated in the presence Failure to do so will impact on the ongoing
barrier cream or ointment to prevent of organic substances such as blood or pus39. success of the device.

5
Patients who self-manage need to: 10. Sigler B . Nursing care of clients with upper airway 29. Lyon C, Smith AJ. Abdominal Stomas and Their Skin
disorders. In: Black JM, Matassarin-Jacobs E (eds). Disorders – An Atlas of Diagnosis and Management.
Q Be able to demonstrate how to care
Medical Surgical Nursing: clinical management for Martin Dunitz Ltd, London 2001.
for their exit site before discharge continuing of care. 5th edition. Philadelphia: Saunders, 30. Hanlon M, Heximer B. Excess granulation tissue
1997; 1067-103. around a gastrostomy tube exit site with peritubular
and be provided with written 11. Donlan RM. Biofilms and device-associated infections. skin irritation. J Wound Ostomy Continence Nurs1994;
instructions for routine care of their Emerging Infect Dis 2001;7(2) 21(2): 76-7.
12. NICE Pathways 2012. Prevention and control of 31. Dealey, C (2007) The Care of Wounds: a guide for
device and surrounding skin to healthcare-associated infections overview. Available nurses 3rd edition. Wiley-Blackwell, Oxford.
prevent complications at: http://pathways.nice.org.uk/pathways/prevention- 32. Stephen-Haynes J, Hampton S. Understanding and
and-control-of-healthcare-associated-infections treating overgranulation, 2010. Available from www.
Q Know how to recognise the signs
13. Department of Health. Winning ways: working wcauk.org/downloads/booklet_overgranulation.pdf
and symptoms of infection and together to reduce healthcare associated infection 33. Warriner L, Spruce P. Managing overgranulation tissue
in England. Report from the Chief Medical Officer, around gastrostomy sites. Br J Nurs 2012; 21(5): S14-6,
overgranulation. London: DH, 2003. S18, S20 passim
14. Wong FSY. Use of cleansing agents at the peritoneal 34. Vuolo J. Hypergranulation: exploring possible
catheter exit site. Perit Dial Int 2003; 23(2) S148-S52. management options. Br J Nurs 2010 (Tissue Viability
Any advice given to patients and their 15. Khan MN, Naqvi AH. Antiseptics, iodine, povidone Suppl) 19(6): s4-s8
carers should be simple, consistent iodine and t raumat ic wound cleansing. J Tissue 35. Griffiths J, Joyce J, Scanlon L, Feber T, Firth H. Best
Viability 2006; 16(4): 6-10. practice for gastrostomy tube management. British
and supported by clear information, 16. Wood M. A protocol for care of skeletal pin sites. Nurs Association of Head and Neck Oncology Nurses,
including pictures and diagrams. Where Times 2001; 97(24):66. Bristol 2001.
17. Hadaway L. Polyhexamethylene biguanide dressing 36. Widgerow AD, Leak K. Hypergranulation tissue:
appropriate, information should be — another promising tool to reduce catheter-related evolution, control and potential elimination. Wound
offered in the language of the patient. bloodstream infection. JAVA 2010;15(4):203-5. Healing S Africa 2010; 3(2): 1-3.
18. BhattacharyyaM, BradleyH. Antibiotics vs an 37. Borkowski L. G tube care: managing hypergranulation
antimicrobial dressing for pin-track infection. Wounds tissue. Nursing 2005; 35(8): 24.
References UK 2006; 2,(2): 26-33. 38. Hubner NO, Kramer A. Review on the efficacy, safety
1. Sittig E, Pringnitz JE. Tracheostomy: evolution of an 19. Lynch CR, Fang JC. Prevention and management and clinical applications of polihexanide, a modern
airway. AARC Times 2001. of complications of percutaneous endoscopic wound antiseptic. Skin Pharmacol Physiol 2010;
2. Royal College of Nursing. Guidance on pin site gastrostomy (PEG) tubes. Pract Gastroent 2004; 66-72. 23(suppl 1):17–27.
care. Report and recommendations from the 2010 20. Motta GJ, Trigilia D (2005) The effect of an 39. Lee WR, Tobias KM, Bernis DA, Rohrback BW. In
Consensus Project on Pin Site Care. RCN, London antimicrobial drain sponge dressing on specific vitro efficacy of a polyhexamethylene biguanide-
2011. bacterial isolates at tracheostomy sites. Ostomy Wound impregnated gauze dressing against bacteria found
3. McClave SA, Neff RL. Care and long-term maintenance Manage 2005; 51: 60–3. in veterinary patients. Vet Surg 2004; 33(4): 404-1.
of percutaneous endoscopic gastrostomy tubes. J 21. Leak K, PEG site infections. A novel use for Actisorb
Parenter Enteral Nutr 2006; 30(1): S27-S38. Silver 220. Br J Comm Nurs 2002; 7: 321-25. This ‘made easy’ is supported by an
4. Altman S. Showering with central venous catheters: 22. Phillips PL, Wolcott RD, Fletcher J, Schultz GS. unrestricted educational grant from
experience using the CD-1000 composite dressing. Biofilms Made Easy 2010;1(3). Available from www. Covidien
Dial Transpl 2006; 35(5): 320–27. woundsinternational.com
5. Johnson DW, Clark C, Isbel NM, et al.The honeypot 23. Wolcott RD, Rhoads DD, Bennett ME, et al. Chronic
study protocol: a randomized controlled trial of exit- wounds and the medical biofilm paradigm. J Wound Author details
site application of medihoney antibacterial wound gel Care 2010; 19(2): 45-50, 52-53. Spruce P1, Warriner L2, Keast D3,
for the prevention of catheter-associated infections 24. Donlan RM. Biofilms on central venous catheters: is
eradication possible? Curr Top Microbiol Immunol 2008; Kennedy A4
in peritoneal dialysis patients. Perit Dial Int 2009; 29
(3): 303-9. 322: 133-61. 1. Clinical Director, TVRE Consulting,
6. Temple J, Santy J (2004) Pin site care for preventing 25. Von Eiff C, Jansen B, Kohnen W, Becker K. Infections Stoke on Trent, UK
infections associated with external bone fixators and associated with medical devices: pathogenesis, 2. Home Enteral Feeding Specialist Nurse,
pins. Cochrane Database Syst Rev (1): CD004551. management and prophylaxis. Drugs 2005;65(2):179- County Durham and Darlington NHS
7. Zopf Y, Konturek P, Nuernberger A, et al. Local infection 214. Foundation Trust, UK
after placement of percutaneous endoscopic 26. Johnson S. Haelan Tape for the treatment of
overgranulation tissue. Wounds UK 2007; 3(3): 70-74. 3. Center Director, Aging Rehabilitation &
gastrostomy tubes: a prospective study evaluating risk Geriatric Care Research Center, London,
factors. Can J Gastroenterol 2008; 22(12): 987-91. 27. Harris A, Rolstad, BS. Hypergranulation tissue: a non-
traumatic method of management. Ostomy Wound Ontario, Canada
8. Best C. Percutaneous endoscopic gastrostomy feeding
in the adult patient. Br J Nurs 2009; 18(12): 724-9. Manage 1994; 40(5): 20-3. 4. Clinical Nurse Consultant, Paediatric,
9. Tomlins MJ. Practice change in peritoneal dialysis exit 28. Nelson L. Points of friction. Nurs Times 1999; 95(34): Surgery and Wound Care, Sydney
site care. Renal Soc Aus J, 23 Apr 2008. 72-5. Children’s Hospital, NSW, Australia

Summary
Percutaneous devices create a wound (exit site) that remains open for as long as the device is in-situ. Such
wounds are challenging and require effective management to prevent complications, such as infection
and overgranulation. It is important to keep the exit site clean and dry and to check the device routinely
to ensure it is positioned correctly, is secure and shows no splitting or cracking. For those with long-term
devices, many patients will self-manage at home. As well as knowing how to care for the device and
surrounding skin appropriately, patients should learn how to recognise complications early and know
what to do if these occur.
To cite this document: Spruce P, Warriner L, Keast D, Kennedy A. Exit site wounds Made Easy. Wounds International 2012; 3(2): Available
from: http://www.woundsinternational.com © Wounds International 2012