Treating Peritoneal Dialysis Catheter Exit-Site Granulomas With Chlorhexidine Swabstick: A Pilot Study

Background: Silver nitrate cauterisation is the conventional treatment for peritoneal dialysis catheter exit-site granulomas. However, it requires to be performed by nurses, patients often experience pain and chemical burns. Therefore, the appropriateness and applicability of using 2% aqueous chlorhexidine swabstick as an alternative was explored in two nephrology centres in Hong Kong.Objective: To examine possibility of conducting full trial using chlorhexidine swabstick compared with silver nitrate.Design: A pilot study.Participants: Fort-four patients with exit-site granulomas were equally, randomly allocated to receive chlorhexidine swabstick or silver nitrate.Measurements: Both groups were followed for 6 weeks to evaluate the time of granuloma subsidence and adverse effects. Pain and treatment satisfaction were assessed using numerical rating scale and self-developed questionnaire, respectively.Results: Healing rates were 94.4% (17 of 18) using chlorhexidine swabstick,100% (21 of 21) using silver nitrate (p = 0.46). The mean time of granuloma subsidence was significantly longer when using chlorhexidine swabstick (32.8 days) than silver nitrate (12.3 days, p=0.02). The chlorhexidine swabstick group reported significantly fewer adverse effects (11.1%, 2 of 18, p = 0.01) compared with the silver nitrate group (52.4%, 11 of 21). The chlorhexidine swabstick group had lower mean pain score (0.5 of 11) than the silver nitrate group (2.4 of 11, p < 0.01). The satisfaction scores between the two groups had no substantial difference.Conclusion: Chlorhexidine swabstick took long time to remove granulomas but had similar success rate, less pain, fewer adverse effects than silver nitrate. Additional research is warranted to examine the applicability of chlorhexidine swabstick.