From: How to deal with dialysis catheters in the ICU setting
Choice of the dialysis catheter | |
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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 | Â |
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 |