Prevention of Infection of the Vascular Access – Central Vein Catheters

Guideline Organization

Recommendation (Evidence Level)

Evidence

Comments

CARI-Australia
2000

a) Chlorhexidine or Mupirocin ointment and/or povidone iodine ointment on the catheter exit to reduce local and systemic infection
b) Eradication of nasal Staphylococcus carriage requires regular re-treatment (Level A)

 19. Preventing Staphylococcal-related Bactaeremia and Catheter Sepsis

CSN-Canada
2006

Change catheter exit site dressings at each hemodialysis treatment (Grade D, opinion). Use dry gauze dressings and povidone iodine (Grade C), mupirocin (Grade C), or polysporin
triple ointment (Grade A) at the catheter exit sit

Guideline Chapter 4 – Managing VA Complications
pdf: Pg 18 of 27

EBPG-Europe
1999

VI.3.1
- Access should be a native fistula whenever possible (Level B)

VI.3.3.
- Catheter insertion to be considered as a surgical technique – only by experienced medical staff in a dedicated clean area and under aseptic conditions (Level C)
- Trained staff for dressing changes and catheter manipulation (Level B)
- Catheter connection, disconnection and interventions under aseptic conditions by trained staff; patients wearing a surgical mask (Level A)
- Catheter only used for dialysis and related procedures (Level C)

Guidelines VI.3 Prevention of infection:  Management of the vascular access

KDOQI-US
2001

 - Dressing changes and catheter manipulations by trained dialysis staff only (Opinion/Evidence)
 - Exit site inspection at each session (Opinion)
 - Exit site dressings changed at each session (Opinion)
 - Dry gauze dressing combined with skin disinfection, using either chlorhexidine or povidone iodine, followed by povidone ointment or mupirocin ointment at the catheter exit site are recommended after catheter placement and at the end of each session (Evidence)
 - Minimize contamination at manipulation and accessing the blood stream (Evidence)
 - Surgical mask for nurses and patients at connection and disconnection. Nurses should also wear gloves. (Opinion)

Guideline 15: Catheter care and accessing the patient's circulation

Details: table III-10

UK-Guidelines
2007

 - All renal units should have protocols to ensure that full barrier precautions are followed during insertion of temporary and tunneled central venous dialysis catheters.
 - All central venous catheter connections and disconnections should be performed under aseptic conditions by trained staff.
 - Peripheral and central line blood cultures should be taken prior to starting antibiotics in all cases of suspected catheter-related infection.

Module 3a: Haemodialysis- 7.0 Vascular Access