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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