Chlorhexidine for skin antisepsis

“Chlorhexidine 2% with 70% alcohol is the preferred solution for cleansing of long-term catheter sites. For patients with sensitivities to chlorhexidine 2% with 70% alcohol, chlorhexidine aqueous may be used instead. For patients with sensitivities to chlorhexidine aqueous, povidone solution may be used.” [44]

The importance of skin antisepsis before catheter placement is indicated without mention of preferred antiseptic solution [41]

“For patients older than 2 months, a skin preparation solution containing >0.5% chlorhexidine gluconate and 70% isopropyl alcohol should be applied to the insertion site and allowed to dry before the skin is punctured.” [32]

“Use an alcohol-based chlorhexidine (>0.5%) solution as the first line skin antiseptic agent for central line insertion and during dressing changes. Povidone-iodine (preferably with alcohol) or 70% alcohol are alternatives for patients with chlorhexidine intolerance” [18]

Technique for all connect, disconnect, dressing procedures, catheter manipulations

Clean aseptic technique (use of clean gloves) [44]

Sterile aseptic technique (use of sterile materials) [41]

Clean aseptic technique (use of clean gloves) [32]

“Wear either clean or sterile gloves when changing the dressing on intravascular catheters” [17]

Soaking and cleansing the catheter hub connection site with the cap on, with an antiseptic pad/swab

“Cleanse hub connection site and cap vigorously with the first swab” [44] . “The catheter hub caps or bloodline connectors should be soaked for 3 - 5 minutes in povidone iodine and then allowed to dry prior to separation” [45]

Not mentioned in ERBP 2010 position statement on diagnosis, prevention and treatment of haemodialysis CRBSI, and in 2007/2002 guidelines [41] - [43]

“The hub of HD catheters can be soaked in povidone-iodine solution or wrapped with gauze saturated with povidone-iodine solution for 5 minutes prior to removing the caps” [32]

Not mentioned in CDC/ HICPAC guidelines/recommendations [16] [17]

Disinfection of catheter hub after cap removal

Not mentioned in 2000 Vascular Access Guidelines and in 2006 update [44] [45]

Not mentioned in ERBP 2010 position statement on diagnosis, prevention and treatment of haemodialysis CRBSI, in 2007 and 2002 vascular access guidelines [41] - [43]

“After removing the cap, the hub should be wiped with chlorhexidine, alcohol, or povidone iodine” [32]

“Scrub catheter hubs with an appropriate antiseptic after cap is removed and before accessing. Perform every time catheter is accessed or disconnected” [18]

Catheter exit-site dressing

“Changing the catheter exit-site dressing at each HD treatment, using either a transparent dressing or gauze and tape” [44] “Use of dry gauze dressing… at the catheter exit-site are recommended after catheter placement and at the end of each dialysis session” [45]

“With long-term catheters, gauze is the preferred choice. The catheter exit-site should be covered by a dressing as long as the catheter remains in place. The exit-site should be inspected at every HD session, and the exit-site dressing should be replaced on a routine basis if it is no longer clean or intact” [41]

“The catheter exit-site dressing should be changed every 3 days (after each HD session) if gauze/tape, or every 7 days if transparent dressing is used in addition to whenever the dressing is wet or soiled” [32]

“Use either sterile gauze or sterile, transparent, semipermeable dressing. Replace dressings on short-term CVC sites every 2 days for gauze dressings, and every 7 days for transparent dressings. Replace transparent dressings on tunneled or implanted CVC sites no more than once per week (unless the dressing is soiled or loose), until the insertion site has healed” [17]

Application of antimicrobials or antiseptics on the catheter exit-site

“…combined with skin disinfection using povidone iodine ointment or mupirocin ointment at the catheter exit site are recommended after catheter placement and at the end of each dialysis session” [45]

Not mentioned in 2006 update [44]

“Application of antibiotic ointment at the exit-site should be considered after catheter placement until site has healed but should be discontinued after healing” [41]

Recommended routine application of povidone iodine or triple antibiotic ointment at the time of dressing change [32]

“Use povidone iodine antiseptic ointment or bacitracin/gramicidin/polymixin B ointment at the hemodialysis catheter exit site after catheter insertion and at end of each dialysis session only if this ointment does not interact with the material of the HD catheter per manufacturer’s recommendation” [17]