deborah j. brouwer-maier, rn, cnn director, dialysis ... j. brouwer-maier, rn, cnn director,...

Deborah J. Brouwer-Maier, RN, CNNDirector, Dialysis Access Initiatives

Fresenius Medical Services Deborah.Brouwer-Maier@fmc-na.com

Ideal Exit Site Location-must be customized to the patient

Not into breast tissue for females and not near the nipple for both sexes

Able to access so the female can still wear a bra Allow a flat area for enough dressing to be applied

to the skin to keep it intact Simple answer- if it is your

CVC where would you want the exit site?

Non-tunneled CVC must have suture intact at all times

Use should be limited acute hospital settings

Tunneled Cuffed Catheter is most commonly sutured for the healing period of 10-14 days

Sutures left in too long become breading ground for infection!

Ideal catheter has a removable suture wing that is removed once sutures are removed

Need placement confirmation that CVC is in correct placement for dialysis use

Need order to remove sutures in 10-14 days (exit site and venotomy site)

Need CVC device card to be given to the patient and information shared with the dialysis unit (this is an FDA implantable device so the device rand, name and lot 3 needs to be recorded in case of any recalls or issues)

Created and Tested by Nurses at Central Manchester University Hospitals, UK

S. aureus biofilm detected by scanning electron microscopy.Picture courtesy of Lavern M. Vercaigne, Faculty of Pharmacy, University of Manitoba. S. aureus, Staphylococcus aureus.

http://www.cdc.gov/dialysis/prevention-tools/

New CDC Program

Scrub the Hub

Note: CVC running reversed!

Patient Comfort Device

ClearGuard™ HDWith Chlorhexidine Rod inside Cap

BioPatch

TEGO connectors

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“Do not submerge the catheter under water. Showering should be permitted if precautions can be taken to reduce the likelihood of introducing organisms into the catheter (e.g., if the catheter and connecting device are protected with an impermeable cover during showering)”.* Strongly Recommended

*MMWR Guidelines for the Prevention of Intravascular Catheter Related Infections, 2011

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Peer review publication of 209 ESRD catheter patients residing in 34 different states being treated by 175 unique physicians who used the CD-1000 while showering showed a 75% reduction in catheter-related infections Before use of CD-1000: 1.83 infections per 1000 catheter

days (161 infections in 69 patients) With use of CD-1000: 0.47 infections per 1000 catheter days

(9 infections in 9 patients)

Altman, et al., “Reducing catheter infections through use of the CD-1000: a retrospective review of a unique catheter specific composite dressing,” Journal of Vascular Access, 2008

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NEXSITETM HD CATHETER

MediHoney? No resistance issues!

Catheter exposure poses increased risk of morbidity and mortality

Routine care needs have more that Routine Attention

Best Practices can reduce risk of BSI for the hemodialysis catheter patients