Highly permeable transparent, transparent polyurethane or gauze dressings are all appropriate for use on exit sites of central venous lines for use in haemodialysis. (Level I evidence) Long-term central venous line dressings should be changed weekly or sooner if soiled or no longer intact. (Level II evidence) (Suggestions are based on Level III and IV
evidence) Chlorhexidine impregnated dressings should be used to reduce PD-0332991 solubility dmso catheter related bacteraemia compared with standard dressings. Preferably a transparent dressing should be used to protect the exit site as it allows for clear visibility and assessment of the site. If there is bleeding or oozing, it is suggested a dry dressing is used until this is resolved. It is suggested the dressing be changed on a weekly basis to reduce irritation of the skin and minimize the introduction of foreign agents. The dressing should be changed sooner if it becomes soiled or loose. It is suggested adequate hand hygiene is maintained with the use of alcohol based hand rub or other agent if contraindicated. Aseptic technique should be maintained at all times when accessing or dressing the central venous site.
It is suggested that this guideline is used in conjunction with the KHA-CARI guideline on prevention of dialysis catheter infection. We recommend application of either topical agents or intraluminal lock solutions
for the Galunisertib solubility dmso reduction of exit-site infection and catheter-related bacteraemia. Options of topical agents include mupirocin 2% ointment and polysporin. Intraluminal lock agents include both antibiotic based and non-antibiotic-based solutions. Ideal antibiotics and optimal doses are yet to be defined. (Level 1 evidence) (Suggestions are based on Level III and IV evidence) Basic care of catheter management should be reinforced aminophylline in every dialysis unit. An aseptic protocol has been shown to reduce CRI. Choice of topical agents and/or intraluminal lock solutions should be unit-based, with consideration given to the availability, safety, and costs of the agents used. There are no studies to-date comparing the efficacy of topical agents versus intraluminal lock solutions, or the use of both topical agents and intraluminal ALS together in reduction of CRI. There is thus insufficient evidence to recommend one over the other. The potential emergence of antimicrobial resistance remains a concern. Use of either strategy should be considered in patients who rely on long-term tunnelled-catheter, have previous infective complications and/or have prosthetic devices. No recommendations possible based on Level I or II evidence. (Suggestions are based on Level III and IV evidence) Catheter removal should be the first consideration in treatment of CRI.