Use of cleansing agents at the peritoneal catheter exit site.

Heavy bacterial colonization results in exit-site infection. Antiseptic and non antiseptic agents have both been used for exit-site cleansing. An ideal cleansing agent should not only reduce the number of microorganisms, but should also be harmless to the body's defenses and should not interfere with wound healing. In vitro studies using animal cells have demonstrated that some antiseptic agents have adverse effects on wound healing. Strong cytotoxic antiseptics should be discouraged in exit-site cleansing. In choosing an appropriate cleansing agent for exitsite care, the phase of wound healing, the condition of the exit site, and the goal of cleansing should be taken into consideration. Antimicrobial soap is recommended for cleansing a healed exit site, but biocompatible solution is preferred for the postoperative, infected, or traumatized exit site. In vivo studies on the effectiveness of some cleansing agents are still lacking, and clinical study of exit-site cleansing is needed to determine the most effective agents for the task.

Effect of a home exercise program based on tai chi in patients with end-stage renal disease.

OBJECTIVE: Previous reports have documented the benefits of exercise on the well-being of renal patients. However, fewer than 50% of our end-stage renal disease (ESRD) patients engage in regular exercise. To promote exercise, we implemented a home-based exercise program. The aim of the program was to reduce barriers to exercise by helping patients to exercise at their convenience and without the need to travel. The effect of the program was evaluated 3 months after implementation. PATIENTS AND METHODS: Each study participant received a videotape that demonstrated 30 minutes of low-capacity aerobic exercise. Participants were advised to exercise by following the demonstration on the videotape. Encouragement was given over the telephone. Self-reports on practice were recorded in a log book that was also provided. The effect of the program was evaluated by comparing outcomes data before, and 3 months after, implementation of the program. Outcomes assessment included functional mobility (timed "Up & Go" test), muscle flexibility ("Sit & Reach" test), physical capacity ("Six-Minute Walk"), and quality of life [Kidney Disease Quality of Life Short Form (KDQOL-SF)]. RESULTS: The program began with 72 participants. Over time, 39 dropped out. The remaining 33 participants included 11 men and 22 women with a mean age of 52.8 +/- 9.8 years. They exercised 3 - 7 times weekly. Significant improvements were observed in the timed "Up & Go" (p = 0.003) and "Sit & Reach" (p < 0.001) tests. Improvements in the "Six-Minute Walk" (p = 0.130) and in KDQOL-SF scores for emotional well-being (p = 0.456), pain (p = 0.100), burden of kidney disease (p = 0.061), and general health (p = 0.085) were statistically insignificant. CONCLUSIONS: Physically, patients with ESRD benefit from home-based low-capacity aerobic exercise. A home-based program provides an alternative to outdoor and group exercise. In view of a high drop-out rate, intensive promotion and encouragement should be considered to achieve a positive outcome.