catheter care

[celle507]

Just wondering what you all are using in your units--

What do you do in your unit to prevent tunneled catheter infections? What do you use to clean the site (Ex-Sept, chloraprep, etc.)?

Anyone using antibiotic locks? antibiotic ointments? biopatches?

If you are using chloraprep and antibiotic ointments, anybody seeing a lot of skin irritation?

Are you using occlusive dressings, transparent dressings?

We have had a lot of infections in our unit so we are using chloraprep, antibiotic ointment, AND antibiotic locks (gentamicin/citrate). BUT, it seems like a lot of patients are developing skin irritation from the ointments. I am really interested in this topic.

And if someone has an exit site infection (with negative blood cx), how are the providers treating it? vancomycin 1 g x 1 dose or vancomycin 500 mg x 3-5 doses. It seems there is no standard treatment protocol and everyone treats differently.

Anybody have any suggestions what work the best (aside from strict aseptic technique of course)?

Thank you for your replies!

[dialysisnurseLC]

I work chronic in center HD. We clean the site with ex Cept cover the site with a 3x3 gauze and dress the site with a tegaderm. We clean the legs of the catheter with the except for catheters... We don't use gentamicin unless there is a dr order... In my whole 1 yr of dialysis I have never seen an infected cath site. If there was something questionable the dr orders loos futures and will order 1 gm of vanco the last hr of tx. I hope that helps..

[acutedialysis]

We utilize Chloraprep, antibiotic cream and island dressings. Our infection rate is very low. In one of our acute hospitals we use the biopatch with great success, but it stays on for a week. I'm not sure if more mobile patient (versus a hospitalized patient) would get a tegraderm to last a week. Maybe look at your access care policy. How often do you change gloves? If your infection rate is high, something is wrong.

[Marisette, BSN, RN]

I believe ointments have alcohol and may be irritating to the skin. We use genamicin CREAM at the catheter site, gauze dressing and secure with adhesive tape. Sometimes strong cleansers cause skin irritation. Skin that is irritated, may have tiny tears and bacteria may enter and cause infections. Aggressive cleaning of the area may actually be irritating to the skin and cause problems. We tend to use oral antibiotics and topical antibiotic cream (gentamicin or bactrovan cream) for infections at the catheter site, and save intravenous antibiotics for systemic infections. The catheter site discharge can be sent to the lab for culture and senstivities to determine what bacteria is present at the site. Usually, the gentamicin CREAM and gentle cleansing with 0.9% normal saline solution for several days or weeks takes care of the problem. Patients with hemo. catheters get cleansed with the saline, home patients with peritoneal catheters may use soap and water, then apply gentamicin cream. Gentamicin Cream may also be used for prevention of infection for patients prone to develop catheter site infections (prophylactically) .