8% in 2008).[16] In the Australian dialysis population, infection accounted for 11% of mortality, the third most common cause of death following dialysis withdrawal (35%) and cardiac disease (43%)[17] Of the 11% (n = 148), approximately 25% was secondary to bacterial septicaemia. Similarly, 17% of mortality was attributed to infection in the New Zealand dialysis population. CRI has an enormous adverse impact, not only at individual level of increased morbidity and mortality, but also financial implications with the costs of hospital admissions, antibiotics use and catheter change. Cost-per-infective-episode has been estimated to be between US$3703 and US$29 000 in the USA from non-tunnelled catheters in intensive care
units.[18] With the high incidence of catheter use in incident haemodialysis patients, it is imperative to develop strategies to prevent https://www.selleckchem.com/products/acalabrutinib.html and treat CRI. There have been studies examining the application of topical agents to the exit site to prevent both local and systemic infections. Intense interests have been concentrating on the use of antimicrobial lock solutions (ALS) to reduce CRI in recent years. Once bacteraemia has occurred, catheter removal, with or without delay in insertion of a new vascular catheter, is often indicated. Alternative therapy such as combining systemic antibiotics and ALS, without changing the catheter, has been evaluated in the literature. The objective of this guideline is to identify appropriate recommendations for central mTOR inhibitor venous catheter insertion and catheter care, as well as prevention and treatment of CRI in dialysis patients with tunnelled catheters in-situ. Dressing type, frequency of dressing changes and cleansing solutions will be addressed. The use of topical agents or intraluminal lock solutions will be investigated as will be the various treatment strategies for CRI. The use of real-time ultrasound guidance is strongly recommended for the placement of haemodialysis catheters and results in improved rates of successful catheter
placement, and reduced rates of both haematoma formation and inadvertent arterial puncture. (Level 1 evidence) (Suggestions are based on Level III and IV evidence) The adherence to strict aseptic technique is proven to reduce the catheter related bacteraemia rate and all units should therefore audit this practise. Tunnelled haemodialysis CHIR99021 catheters should be used as they are associated with lower rates of catheter related bacteraemia, catheter dysfunction and vascular damage (venous trauma, and stenosis) compared with temporary non-tunnelled catheters. The right internal jugular vein is the preferred insertion site with respect to ease of access and lower rates of short and long-term complications. In ICU settings, subclavian catheter placement has excellent short-term outcomes compared with jugular and femoral approaches but has significant long-term sequelae recommending against their use.