UNIT HEMODIALISA RS PELNI PETAMBURAN JAKARTA

An arteriovenous fistula is associated with fewer

complications than a central venous catheter (CVC) in patients
on chronic hemodialysis (HD), and its use is strongly
encouraged in children weighing more than 20 kg, however,
CVCs continue to be widely used despite the fact that CVC-
related infections are a major source of morbidity.
The choice of exit-site and hub cleaning solution is a key point
in the prevention of exit-site infection (ESI), tunnel infection
(TI), and bloodstream infection (BSI) in patients on HD, and the
findings of many studies, meta-analyses, and guidelines
suggest that a chlorhexidine gluconate solution is better than
a povidone-iodine solution for this purpose
The aim of this retrospective study was to compare the
efficacy of chlorhexidine-based solutions with that of a 5%
povidone-iodine solution in terms of the incidence of CVC-
related infections in children on HD.
MATERIALS AND METHODS
The incidence of ESI, TI, and BSI was retrospectively
assessed in two groups of tunneled CVCs
1 January 2011 and 30 June 2012
The 5% povidone-iodine group consisted of 14 CVCs (exitsite and hub care) in 10 children,
whose median age at the time of CVC placement was 11.8 years (range 1.2–19.2)

2011-2012 2012-2014

1 August 2012 to 31 January 2014

A 0.5% chlorhexidine gluconate/70% isopropyl alcohol solution was
used for exit-site care, placement was 10 years (range 1.2–19.2).

and a 2% chlorhexidine gluconate/70% isopropyl alcohol spray was

used for the hub care of 13 CVCs in 10 patients (chlorhexidine
group), whose median age at the time of CVC placement was 10
years (range 1.2–19.2).
MATERIALS AND METHODS
MATERIALS AND METHODS

Heparin (5000 U/mL) was used as the lock solution at the end of
each HD session; a urokinase lock (5000 U/mL) was used

a urokinase lock (5000 U/mL) was used at the end of the midweek
HD session, or in the case of catheter malfunction, defined as a
reduction in blood flow rate (Qb) of >20% in comparison with
baseline, a prepump arterial pressure of less than −250 mmHg, or
a failure to aspirate blood from the access
MATERIALS AND METHODS

The routine exit-site care included the strictly sterile use of the
CVC by trained nurses only; the use of sterile gloves and surgical
masks whenever the CVC was accessed, and gauze dressings
at the exit site; and no systemic antibiotic prophylaxis.

The CVC exit site was cleaned every other session during both
study periods; there were no differences in the CVC management
protocol between the two periods with the exception of the
cleaning solutions.
MATERIALS AND METHODS
Each episode of ESI, TI, and BSI was recorded on the basis of the
diagnostic criteria defined by the National Kidney Foundation
Dialysis Outcome Quality Initiative Guidelines.

Exit-site infection was defined as inflammation confined to the

area surrounding the catheter exit site, not extending above the
cuff, with a positive exudate culture.

Tunnel infection was diagnosed if the catheter tunnel superior to

the cuff was inflamed, painful, and draining through the exit site.
MATERIALS AND METHODS

Bloodstream infection was defined as probable BSI: i.e., a blood

culture positive for bacteria in a symptomatic patient with no
other apparent source of infection, with defervescence after
antibiotic therapy with or without catheter removal.

The incidence of ESI, TI, and BSI was calculated in both groups,
as well as the infection-free and overall survivals of the catheters
during the two study periods.
MATERIALS AND METHODS

STATISTICAL ANALYSIS

The data are expressed as median values and ranges, and were
statistically analyzed using the Mann-Whitney test for continuous
variables and the chi-square test for dichotomous variables.

Kaplan–Meier analysis was used to evaluate catheter survival.

A P value of <0.05 was considered statistically significant.

RESULTS

[10 episodes] [1 episode]

Staphylococcus epidermidis (6) Staphylococcus aureus (1)

Staphylococcus aureus (2)
Escherichia coli (1)
Citrobacter koseri (1)
RESULTS

[1 episodes] [0 episode]
RESULTS

[5 cases] [1 case]

Fusarium spp (1) S. aureus (1)

S. epidermidis (2)
S. Aureus (1)
Burkholderia pickettii (1)
RESULTS
The probable reason for
the lack of statistical significance
was the small number of enrolled
patients.
A reduction in the incidence of CVC-related infections can have
a dramatic impact on the management of children on chronic
HD as it leads to a reduction in the use of antibiotics and
hospitalization, reduces the need for CVC replacement, and may
even reduce mortality.

As optimal CVC management is the cornerstone of infection

control, identifying the most effective strategy is of utmost
importance.

Our study can contribute to this in that it emphasizes the

importance of exit-site and hub cleaning solutions.
 In conclusion,
our study shows that, in comparison with 5% povidone-
iodine, the use of a 0.5% chlorhexidine gluconate/70%
isopropyl alcohol solution for exit-site care and a 2%
chlorhexidine spray for hub care is associated with a
reduction in the incidence of ESI, TI, and BSI in children on
chronic HD.
THANK YOU