We currently change dialysis catheter dressing changes with each and every treatment, however all other central lines and PICC's are changed weekly. Does anyone know where this supposed "best practice" originates from r/t dialysis dressing changes w/each treatment. We utilize CHG discs, which even add more to the expense. I question how all other central lines are weekly, whereas dialysis catheters are every other day? Do we predispose the pt. to an increased risk of CLABSI as a result of this current practice. Does the old dinosaur practice predate the production of CHG discs that are instructed to change weekly?
Because a patient with a CVC is 7 times more likely to have an infection than that of a patient with an AVF/AVG, CDC recommends and CMS requires that you check the insertion site at each treatment. Since you will be removing the dressing to do this and exposing the insertion site to airborne bacteria then it is required that you perform a cleaning of the site before dressing it again until next treatment. PICC's usually are in place when receiving a course of ABX therefore chance of infection is reduced, central lines are not a long term placement and the patient is usually admitted during this time and nursing staff are changing the dressing prn which is usually a sterile process while admitted. Central lines are also usually removed upon discharge correct? This is something that is usually with a patient for a minimum of 3 months and for some years. A study was done showing that the mortality rate of a patient with a CVC is significantly higher within the first 90 days of dialysis than that of a person with an AVF/AVG. I think all these signs point to the increased frequency of CVC dressing changes.
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