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Table 3 Prevention of dialysis catheter infection

From: How to deal with dialysis catheters in the ICU setting

Choice of the dialysis catheter
Lumens No difference between dual lumen catheter and two single lumen catheters placed side by side in terms of infection
Tunnelization Not recommended for initiating RRT
Antimicrobial-coated catheters Use not currently recommended and should be limited to units with high rates of DC infections despite implementation of adequate preventive strategies
Choice of the insertion site
  No difference between femoral or jugular sites in term of infection.
  Physicians should be vigilant with femoral site in case of high body mass index, and with internal jugular site in case of low body mass index
Insertion procedures
Hygiene procedure Surgical hand disinfection
Depilation Wear a long-sleeved sterile gown, sterile gloves, and cap
  Use a large sterile drape
  If hairs disturb vascular puncture or dressing occlusion
Skin preparation >0.5% alcoholic chlorhexidine or alcoholic povidone iodine
Antibiotic prophylaxis Ultrasound guidance Not recommended. May be proposed for internal jugular DC placement
During RRT  
Hygiene procedure Use strict aseptic conditions for every DC manipulation
Dressing Limit manipulation
  Avoid use of dialysis catheter for perfusion or blood samples, except in case of life threatening emergency
  Semipermeable transparent polyurethane dressing, sterile gauze
Antimicrobial lock solutions Before applying a new dressing, clean skin with antiseptic solution, 0.5% alcoholic chlorhexidine or alcoholic povidone iodine
  Change in case of disruption or soiled dressing
  Change dressings at every dialysis
  Not recommended for prevention
Local ointments Not recommended for ICU dialysis catheter
Catheter Catheter replacement not scheduled
  Limit indwelling time and remove as soon as unnecessary