Dialysis •
The CVAD care record should be used for all HD patients with CVC and all elements completed every dialysis session (normally, three-times-per-week). Date and time of insertion of the line should be recorded in the patient’s notes and date of insertion added to the dressing if applicable.
• • •
Assessment and inspection of the catheter exit site should be performed and documented every dialysis session.
All manipulations should be performed in accordance with the aseptic non-touch technique (ANTT) for the administration of drugs and fluids by intravascular device procedure.
ChlorPrep (chlorhexidine gluconate 2 % weight/v aqueous solution) should be used for dressings.
• All CVAD for HD patients should be removed by a competent practitioner when no longer required and CVC line tips should be sent to microbiology for culture.
• •
Line removal should be clearly documented in the patient notes.
All elements of the daily care record must be completed every dialysis session.26
Conclusions
The incidence of the dialysis line related infection has fallen by 75 % in the six months from September 2006 to March 2007, since TSC 46.7 % was introduced compared with a six-month period prior to its introduction.
There were problems with adverse effects reported since the introduction of TSC 46.7 % as a line-locking agent in all patients with dialysis catheters in September 2007. Adverse effects experienced by the patients have been mild and have not caused the patients to discontinue with its use.
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The use of TSC 46.7 % has proven cost effective when looking simply at the reduced spending on urokinase (down by approximately 90 %) and heparin (down by approximately 95 %). Reduced expenditure on admissions, line removals and the treatment of infection should also be considered. The use of TSC 46.7 % solution to lock the catheter line has been proven to reduce infections to HD patients.
Changing catheter lock from heparin to TSC 46.7 % will not work alone to prevent and decrease the rate of CRBI but it is essential to uphold best clinical practices; the use of sterile procedure in inserting lines and adequate catheter care using a unit-based CVAD care record. The trust has launched the first central venous access service in the country with a dedicated theatre suite supporting safe line insertion. All CVAD for HD patients is inserted in the vascular access unit and contribute to the reduction of MRSA bacteraemia rate in the CUHNFT.
Multidisciplinary education of the patient, the nursing staff and all dialysis unit personnel will be helpful in decreasing infections. We now have over five years of clinical experience with TSC 46.7 % and appear to be cost-effective, and it reduces CRBI for maintenance of long term CVAD for HD patients. It reduced expenditure on admissions, line removals and the treatment of infections.
The CUHNFT HD unit adheres to the best clinical practice on the prevention and management of CRBI. Reducing the incident rate of MRSA bacteraemia in our unit raised the profile of the hospital nationally and we triumphed in the top award as best acute NHS organisation in the UK. n
Staphylococcus aureus Biofilm Formation, Infect Immun, 2005;73(8):4596–606.
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