When catheter-related infection rates appeared to be on the rise in our hemodialysis centre in our third year of operation, a continuous quality improvement initiative looking at current practice was begun.
Many factors influence catheter-related sepsis.
We use a large number of catheter, and they stay in place for months, both known risk factors that may result in infection of the exit site or of the bloodstream. Many guidelines have been written regarding physician considerations during insertion, including the preferred site, use of tunneled catheters, intravenous antimicrobial prophylaxis, types of catheters, barrier precautions, cutaneous antisepsis, exit site ointments, catheter replacement, and so on. Since the maintenance of these catheters, once inserted, is mainly left to nurses, this article will focus on the nursing aspects of catheter care once the catheters are in place. Our current practice, already documented in written policies and procedures, was reviewed and compared to the information found in the literature. After discussion with our nephrologists, and trials of a variety of products, our procedures were modified and staff education begun.