Temporary Vascular Access Temporary Vascular Access HemodialysisHemodialysis: Looking for New : Looking for New Solutions for the KnSolutions for the Knownown Problems Problems

Methods:Methods:

The Institute of Nephrology and Hypertension, Department of medicine, Department of Vascular SurgerySheba Medical Center, Israel

Elena Elena BadaevBadaev RN MA, RN MA, NatalyNataly ElshteynElshteyn--AnopolskyAnopolsky RN BA, Vered Shani RN MA, RN BA, Vered Shani RN MA, Yafa Peleg RN BA, Yafa Peleg RN BA, EmannuelEmannuel Ronny Ronny ReinitzReinitz MD, Aharon MD, Aharon KnechtKnecht MDMD

The use of central venous catheters (CVC) for chronic hemodialysis access is an ongoing phenomenon

The use of Silver impregnated dressings (Silvalpad) to the catheters’ exit- site treatment was adopted in our department began 04.2006.

The purpose of the study:to examine whether the use of the Silvalpad dressing is effective in the prevention of catheter exit-site infection, and have the effect on the catheter’s duration use.

Results: Results:

ConclusionConclusion

The study is Retrospective: data was collected from 01.01.2005 to 08.2008

Dressing Effecicacy

fi

days

Introduction Introduction

Catheter-related infections can lead to extended hospital stays and greatly increased treatment costs. The infection may be localized at the catheter exit-site, in the subcutaneous tunnel or within the catheter lumen

In light of our finding we conclude:• Catheter-related infection as cause for emergent catheter removal was significantly less in the Silvalpad Dressing Group compared to the Controls. • Silvalpad has low relative risk to development exit-site infection compared to Dry Sterile Dressing. Silvalpad Dressing was highly effective in preventing exit-site catheter infection. • The average age of the Study Group was higher than that of the Control Group. This may explain the higher NON-catheter-related-mortality in the Study Group compared to the Control Group.

correlate withnotDressings did SilvalpadThe use of •the duration of catheter use. This might be explained by the fact that we excluded from our study all patients with catheters that continue to function.

We intend to continue in our studies of catheter-related infection in order to develop new treatment methods.

• Silver is re-emerging as a preferred antimicrobial in many infection control applications.

• The silver-impregnated surface of the dressing prevents bacterial growth while the foam surface of the dressing absorbs the moisture and secretions from the catheter exit-site.

Catheter Duration Cause for catheter removal

20

40

0

60

80

120

140

117±10085±75

• The centralized listing of catheter’s insertion and catheter’s removal• Documentation of catheter’s removal causes• Calculation of Silvalpad Dressing Efficacy in the preventing catheter’s exit-site infection

Statistical analysis: (α = 0.05)

The research tools:

• T-test for comparison between groups’average catheter duration • Relative size’ comparison between Type of Dressing and Cause for Catheter removal

Study population:Inclusion Criteria:

Exclusion Criteria:

catheters that were --Dressing Study GroupSilvalpad•inserted during 2007 and were removed until 08.2008

catheters that were inserted during --Control Group•2005 and were removed until 04.2006(the exit-sites were treated by Dry Sterile Dressing)

• Brief Catheter Duration (up to 7 days) • Patient’s relocation to other hemodialysis units• Catheters that continue to function [not removed]

Study GroupSilvalpad Dressing

Control GroupDry Sterile Dressing

The period: 01.2007 - 08.2008

The period:01.2005 – 03.2006

57 patients age 68±14.5:32 men (56%), 25 women (44%)

65 patients age 65±14:36 men (55.4%), 29 women (44.6%)

64 catheters inserted during 2007

5 catheters continued to function until 08.2008

87 inserting catheters during 2005

2 catheters were removed in 20071 catheter continues to function (08.2008)

59 CVC 84 CVC

122 patients with CVC

The sample:

p > 0.05

13.1%

35.7% 33.3%28.8%

8.5%

42.4%

Study Group

Control Group

15.3%19.0%

0

10

20

30

40

50

60f (%)

p < 0.001

p < 0.005

p > 0.05

p > 0.05

Routine:Removal to AV AccessKidney TransplantationStopping HD treatment

Non Catheter-Related Mortality:

Cardio-vascular problemsSeptic Foot

Other factors

Catheter –relatedInfection:

Exit-site infectionFever Sepsis

Other causes:Pulling out by itself

Bleeding from exit-siteLack of catheter’s function

42.4%35.7%

28.8%

13.1%8.5%

33.3%

19.0%15.3%

59

Catheter-related infection

removal

28

84

Relative Risk = 0.25

Non Catheter-related infection

Removal

Total Catheterremoval

Silvalpad Dressing Efficacy = 75.5%

5

54 56

0

15

30

45

60

75

90catheters

59 54

84

5

28

56

Recommendation for Practice Recommendation for Practice A A SilvalpadSilvalpad Dressing Dressing

• Improper management of the catheter exit-site is one of the major reasons for the development of infection.• Silvalpad dressing is part of our standard protocol for the care of dialysis catheters.• The Silvalpad dressing is included in the sterile set for catheter exit-site treatment.• Documentation of exit-site condition carried out before every hemodialysis treatment.

We recommend using the Silvalpad Dressing because it is a safe and easy way to prevent catheter-related infections.