Currently at our facility we are reassessing infection prevention standards regarding tunneled dialysis catheters. I was wondering what others were using for dressings over dialysis catheters. Are you using transparent dressings? Guaze dressing? bandaids (something we are seeing at our facility)? Also if anyone has any research articles or standards of practice protocols on this it would be greatly appreciated.
Are you talking about tunneled catheter with a subcutaneous cuff? If so, some physicians will allow no dressing after the cuff has healed and tissue has grown into it. If you are referring to tunneled catheters without a cuff, I would follow the same policy for dressing any other CVC. The only difference with a dialysis catheter is that antiseptic ointment has been shown to be beneficial while it is not recommended on other CVCs. There is no difference in the infection risk of a TSM vs gauze and tape. TSM has the advantage of remaining longer if it is adherent, clean and dry. And you can see the site better. Bandaids for a non-cuffed catheter are not recommended by any organization and will not provide the protection needed. So first look at the type of catheter being used.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Hi Lynn,
Thank you for your help. I wondered if you have found any literature recommending TSM dressings for tunneled dialysis catheters with cuffs. Our facility is having a high infection rate in dialysis catheters and I am having trouble finding literature on this topic. Thank you once again.
Sincerely,
Meghan Mullally R.N.
I don't recall anything specific about published articles on dressings for dialysis catheters. But before you go changing the dressing policy, you must look at several factors in your problem with BSI. How long have these catheters been in place before they are presenting signs of infection? Local infection , tunnel infection, or bloodstream infection? Local infection at the exit site within the first week of dwell is related to insertion technique. Tunnel infection could be several factors. Bloodstream infection especially after the first week of dwell time is not related to the skin and therefore the dressing is not your issue. Catheter hub management is your issue because organisms are being introduced through the catheter lumen. So you need to look at factors such as how these lines are capped, what type device, how are they cleaned before each use, use of infusion other than dialysis, etc.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I recently searched for articles/literature to help our dialysis staff, and couldn't find any. NKF didn't have on their website. I also called them, and they couldn't help me.
Preventing infections is a multifaceted challenge - standardized education and materiels used, regular education of all staff who touch the lines for any reason, limiting of variability of devices/materiels, regular quality data collection and analyses, direct clinician accountability (ALL clinicians); there are many ways to create line associated infections, and we must address every single one....doesn't take much to cause a life threatening infection, not to mention possibly causing loss of a patient's life-saving vascular access device.
Tunneled catheters with cuff should be kept sterilely dressed until the cuff/tissue has healed.
Mari Cordes, BS RN
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center