H7(W)
DEVELOPMENT AND VALIDATION OF A HAEMODIALYSIS CATHETER EXIT
SITE EVALUATION TOOL
Makanjuola, D1, Anwar, S1, Arthur, J1, Steele, M1, Swift, P1
1
St. Helier Hospital, Surrey
INTRODUCTION: Catheter related infection is an important cause of morbidity and mortality
in dialysis patients. A systematic approach to the evaluation and care of the catheter exit site for
peritoneal dialysis has been established by Twardowski and Prowant. Currently there is no
similar tool available to evaluate exit sites of haemodialysis catheters.
METHODS: We have developed an exit site scoring system which aims to provide a
systematic method of exit site evaluation and thus will hopefully help improve the identification
of possible exit site infections (ESIs). The intention is that any member of the dialysis team
should be able to look at the exit site at any haemodialysis session and make an assessment of
the exit site using straightforward objective clinical signs. The presence of one or more of these
signs is awarded a score. The total score then guides the management of a potential exit site
infection. We have undertaken a validation exercise by getting various members of the medical
and nursing team to assess a panel of different exit-site photographs to see what the interobserver variation in scoring was. The sample size was small (n = 15), but the concordance with
regard to discriminating between scores greater or less than 4 was >80%. We are in the process
of carrying out a validation exercise on a larger group.
DISCUSSION: Since we introduced the scoring system as part of a catheter care bundle in
2007, we have noticed a reduction in ESIs by about 60%.
CONCLUSION: While we cannot completely attribute the reduction in exit site
infections to the scoring system alone, we have found that it has led to a significant
reduction in the number of inappropriate exit site swabs, thus preventing inappropriate
administration of antibiotics. We believe that this scoring system will help to
standardize the practice of identifying ESIs and improve care of the exit site in the long
term.