Deborah J. Brouwer-Maier, RN, CNN
Director, Dialysis Access Initiatives
Fresenius Medical Services
Deborah.Brouwer-Maier@fmc-na.com
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Ideal Exit Site Location-must be customized to the
patient
Not into breast tissue for females and not near the
nipple for both sexes
Able to access so the female can still wear a bra
Allow a flat area for enough dressing to be applied
to the skin to keep it intact
Simple answer- if it is your
CVC where would you
want the exit site?
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Non-tunneled CVC must have suture intact at
all times
Use should be limited acute hospital settings
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Tunneled Cuffed Catheter is most commonly
sutured for the healing period of 10-14 days
Sutures left in too long become breading
ground for infection!
Ideal catheter has a
removable suture wing
that is removed once
sutures are removed
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Need placement confirmation that CVC is in
correct placement for dialysis use
Need order to remove sutures in 10-14 days
(exit site and venotomy site)
Need CVC device card to be given to the
patient and information shared with the
dialysis unit (this is an FDA implantable
device so the device rand, name and lot 3
needs to be recorded in case of any recalls or
issues)
Created
and Tested
by Nurses
at Central
Manchester
University
Hospitals,
UK
S. aureus biofilm detected by scanning electron microscopy.
Picture courtesy of Lavern M. Vercaigne, Faculty of Pharmacy,
University of Manitoba. S. aureus, Staphylococcus aureus.
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http://www.cdc.gov/dialysis/preventiontools/
New CDC Program
Scrub the Hub
Note: CVC
running
reversed!
Patient
Comfort
Device
BioPatch
ClearGuard™ HD
With Chlorhexidine Rod
inside Cap
TEGO
connectors
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“Do not submerge the catheter under water.
Showering should be permitted if precautions can
be taken to reduce the likelihood of introducing
organisms into the catheter (e.g., if the catheter
and connecting device are protected with an
impermeable cover during showering)”.* Strongly
Recommended
*MMWR Guidelines for the Prevention of Intravascular Catheter Related
Infections, 2011
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Peer review publication of 209 ESRD catheter
patients residing in 34 different states being
treated by 175 unique physicians who used the
CD-1000 while showering showed a 75% reduction
in catheter-related infections
 Before use of CD-1000: 1.83 infections per 1000 catheter
days (161 infections in 69 patients)
 With use of CD-1000: 0.47 infections per 1000 catheter days
(9 infections in 9 patients)
Altman, et al., “Reducing catheter infections through use of the CD-1000: a
retrospective review of a unique catheter specific composite dressing,”
Journal of Vascular Access, 2008
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NEXSITETM HD CATHETER
MediHoney? No resistance issues!
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Catheter exposure poses increased risk of
morbidity and mortality
Routine care needs have more that Routine
Attention
Best Practices can reduce risk of BSI for the
hemodialysis catheter patients