title: Exit site care in the Netherlands: the use of guidelines in practice.
abstract: BACKGROUND
  The aim of this paper is to describe the quality of exit site care by evaluating the use of the Dutch exit site guideline over a period of 15 years.
  
  
  METHODS
  The special interest group (SIG) for peritoneal dialysis (PD) analysed results of three surveys concerning general exit site care among members of the Dutch Association for nurses and carers (V&VN), the dialysis and nephrology section.
  
  
  RESULTS
  In 2002 (when no guidelines were available) the survey showed huge diversity in practice, with no definition of the post-operative period after catheter placement and no uniform monitoring of the exit site. There was a difference in use of dressings and exit site care. In 2009, the survey showed that most dialysis centres worked with the first guideline of the V&VN (2006) and exit site classification (2006). However, at this time, there was still diversity in the way exit site care was undertaken. In 2016, there was widespread use of guidelines and classification alongside a more individual approach to practice. Differences occured in use of disinfectant, antimicrobial ointment, swimming and going to the sauna.
  
  
  CONCLUSIONS
  The exit site guideline has been widely used in the Netherlands, improving quality in care and utilising a more individual patient approach in care. However, there are still differences identified in practice for which the evidence-base and evaluation will be undertaken to supplement the guideline and attribute to exit site care practice.
authors.affiliation: Maasstad Hospital, Rotterdam, The Netherlands.
authors.forename: Bettie P
authors.initials: BP
authors.lastname: Hoekstra
authors.affiliation: Care group Noorderbreedte, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
authors.forename: Anneke
authors.initials: A
authors.lastname: de Vries-Hoogsteen
authors.affiliation: Zeeland care, Goes, The Netherlands.
authors.forename: Bieneke
authors.initials: B
authors.lastname: Winkels
authors.affiliation: Maasstad Hospital, Rotterdam, The Netherlands.
authors.forename: Helma
authors.initials: H
authors.lastname: Zevenbergen-Osinga
authors.affiliation: Amphia Hospital, Breda, The Netherlands.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Thijssen-Broers
authors.affiliation: Meander Medical Centrum, Amersfoort, The Netherlands.
authors.forename: Trian
authors.initials: T
authors.lastname: Bellemakers
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000639:trends; D032921:Consensus; D017408:Guidelines as Topic / Q000592:standards*; D006801:Humans; D009426:Netherlands; D010530:Peritoneal Dialysis / Q000451:nursing* / Q000592:standards*; D011787:Quality of Health Care / Q000639:trends; D012956:Societies, Nursing / Q000458:organization & administration; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents
keywords: Clinical guidelines; Exit site care; Peritoneal dialysis