18_2_1
Predictors of hemodialysis central venous catheter exit-site infections
By Lori Harwood, RN, MSc, CNeph(C), Barbara Wilson, RN, MScN, CNeph(C), Bonita Thompson, RN, BA, Elizabeth Brown, RN, and Danae Young, RN
Abstract
Central venous catheter (CVC) exit-site infections contribute to bacteremia and patient morbidity and mortality among patients on hemodialysis. This structured observational study examined predictors of positive CVC exit-site infections. Hemodialysis nurs- es documented the physical appearance of the CVC exit site for sites they believed to be infected and required a swab culture. Additional information that pertained to the catheter, exit-site care and demographic data were also collected. No patient char- acteristics were associated with an exit-site infection. However, the type of dressing (p=0.007) and cleansing solution (p=0.007) used were positively associated with an exit-site infection. Negative exit-site culture reports were more likely to have dress- ings changed weekly (p=0.03). The size of peri-wound erythema (p=0.008) was also associated with a higher incidence of exit-site infections. Patients with dry crust present at the exit site were more likely to have negative culture results (p=0.03). A large number of negative swab culture results (71%) were obtained suggesting that further nursing education is needed. The results of this study contribute to our understanding of the physical charac- teristics of an infected CVC exit site. Given the morbidity and mortality associated with CVC infections, more nursing research is needed in this area.
Key words: central venous catheters, exit-site infections, hemodialysis, nursing assessment
Author Affiliation(s):
Lori Harwood, RN, MSc, CNeph(C), Advanced Practice Nurse, Adam Linton Hemodialysis Unit, London Health Sciences Centre, London, ON.
Barbara Wilson, RN, MScN, CNeph(C), Advanced Practice Nurse, Adam Linton Hemodialysis Unit, London Health Sciences Centre, London, ON.
Bonita Thompson, RN, BA, Former Vascular Access Nurse Case Manager, London Health Sciences Centre, London, ON.
Elizabeth Brown, RN, Hemodialysis Nurse, London Health Sciences Centre, London, ON.
Danae Young, RN, Hemodialysis Nurse, Adam Linton Dialysis Unit, London Health Sciences Centre, London, ON.