This document discusses catheter-related infections in hemodialysis patients. It covers definitions of different types of infections, including exit site infections, tunnel infections, and bloodstream infections. The most common causative pathogens are discussed. Risk factors for infections include the type and location of catheter, as well as patient factors like diabetes or recent hospitalization. Treatment involves antibiotics targeted to the pathogen along with catheter removal or salvage depending on the severity of infection. Antibiotic lock solutions may be used in some cases to reduce infections and allow catheter salvage. The document emphasizes preventing infections through strict adherence to infection control practices and policies.
Prevention of Central Line Associated Blood Stream Infection (CLABSI )[compa...drnahla
Infection Control Guidelines for Prevention of Central Line Associated Blood Stream Infection (CLABSI )
Dr. NAHLA ABDEL KADERوMD, PhD.
INFECTION CONTROL CONSULTANT, MOH
INFECTION CONTROL CBAHI SURVEYOR
Infection Control Director, KKH.
Prevention of Central Line Associated Blood Stream Infection (CLABSI )[compa...drnahla
Infection Control Guidelines for Prevention of Central Line Associated Blood Stream Infection (CLABSI )
Dr. NAHLA ABDEL KADERوMD, PhD.
INFECTION CONTROL CONSULTANT, MOH
INFECTION CONTROL CBAHI SURVEYOR
Infection Control Director, KKH.
It is important to realize that guidelines cannot always account for individual
variation among patients. They are not intended to supplant physician judgment
with respect to particular patients or special clinical situations. The IDSA considers
adherence to these guidelines to be voluntary, with the ultimate determination
regarding their application to be made by the physician in the light of each patient’s
individual circumstances.
Catheter –Associated Urinary Tract Infection, Management, And Preventionsiosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Although large efforts are spent for creating fistula as the primary access, use of Hemodialysis Vascular catheters are still the major access on the first Hemodialysis session and after 4 month whether we would like it or not.
"USRDS 2013"
This procedure is knowledge required for the dialysis, in this PPT include introduction, definition, indication, Advantages, Disadvantages, Nursing care and complication of Arteriovenous graft.
Ventilator Associated Pneumonia (VAP) causes and preventive strategiesVeera Reddy Suravaram
Ventilator associated pnemonia is a cause of concern in today's medical practice due to wide spread of Gram negative pathogens in hospitals and lack of good hygienic practices due to high occupancy rate in ICUs.
It is important to realize that guidelines cannot always account for individual
variation among patients. They are not intended to supplant physician judgment
with respect to particular patients or special clinical situations. The IDSA considers
adherence to these guidelines to be voluntary, with the ultimate determination
regarding their application to be made by the physician in the light of each patient’s
individual circumstances.
Catheter –Associated Urinary Tract Infection, Management, And Preventionsiosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Although large efforts are spent for creating fistula as the primary access, use of Hemodialysis Vascular catheters are still the major access on the first Hemodialysis session and after 4 month whether we would like it or not.
"USRDS 2013"
This procedure is knowledge required for the dialysis, in this PPT include introduction, definition, indication, Advantages, Disadvantages, Nursing care and complication of Arteriovenous graft.
Ventilator Associated Pneumonia (VAP) causes and preventive strategiesVeera Reddy Suravaram
Ventilator associated pnemonia is a cause of concern in today's medical practice due to wide spread of Gram negative pathogens in hospitals and lack of good hygienic practices due to high occupancy rate in ICUs.
Infection control guidelines for Prevention of Peripheral Venous Catheter (PV...drnahla
Infection Control Guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections
Dr. NAHLA ABDEL KADERوMD, PhD.
INFECTION CONTROL CONSULTANT, MOH
INFECTION CONTROL CBAHI SURVEYOR
Infection Control Director, KKH.
Vascular Access Part 1: Reducing risk and increasing catheter longevityCoda Change
The aim of having a structured decision matrix in the approach to vascular access is to reduce catheter-associated complications and to increase device longevity. There are over 15,000 central venous catheters placed in Australia annually. The actual insertion process for placing a central line only accounts for a small part of the 'life span' of that line (approximately 1%), but the choices made at the time of insertion have a huge impact on the longevity of the device and the associated complications. In this introductory talk Evan Alexandrou outlines the top ten tips for reducing complications associated with vascular access devices:
1. Always use ultrasound: Never do a blind puncture
2. Ensure with the site chosen for the catheter that it exits the skin on a flat surface.
3. Consider the Axillary vein in preference for the subclavian vein
4. Use micro-puncture techniques
5. Avoid using a scalpel if possible
6. Avoid catheters being inserted all the way to the hub
7. Use impregnated dressings when possible
8. Use sutureless securing techniques
9. Secure the dressing on a flat surface (refer rule 2)
10. Ensure optimal positioning of the catheter tip by utilising ultrasound or intracavitary ECG
Chronic Infection Related To Tunneled Catheter for Hemodialysis with Presence...komalicarol
Although the recommended vascular access for hemodialysis is
the arteriovenous fistula, tunneled central venous catheters (CVC)
are commonly used for treatment. In hemodialysis patients, infections are the most common cause of morbidity and are the second
most common cause of mortality of which CVCs are common potential causes. Prevention, timely detection, and proper treatment
of infections related to percutaneous vascular accesses are defining
factors in the reduction of complications. The first most common
pathogens that cause infections are gram-positive bacteria (S. aureus and coagulase-negative staphylococci); the second most common cause are gram-negative bacteria (Pseudomonas aeruginosa in
E. coli, Klebsiella pneumoniae, and Acinetobacter baumanii); and
less frequently, fungal infections (Candida Albicans). Although
acute infections can be eliminated with an antimicrobial course,
biofilm infections are not as easily eradicated and may cause recurrent infections that only resolve with the removal of the catheter.
Strict adherence to aseptic measures before, during, and after the
insertion and manipulation of Central Venous Catheters area fundamental preventive measure for catheter-related bacteremia.
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It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
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This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
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Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
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Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
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1. Catheter Related Infections
Dr. Osama El-Shahat
Head of Nephrology Department
New Mansoura General Hospital (international)
ISN Educational Ambassador
3. The most important catheter related
complications which determine catheter survival
are infection and dysfunction.
Infectious episodes are the leading cause for
catheter removal and catheter related morbidity
in dialysis patients.
Catheter related infections
4. Septicemia, access and cardiovascular disease in dialysis patients
First cause of Morbidity.
Second cause of mortality
shani A, Collins AJ, Herzog CA, Foley RN: Kidney Int 68: 311–318,2005
Prospective study of 526 incident patients starting RRT. 1 year follow
up. Univariate analysis:
The most common single reason for admission was creation of &
complications to vascular access for HD.
The use of temporary vascular access for HD were associated with prolonged
hospitalisation & repeated admissions.
Metcalfe Et Al. Q J Med 2003; 96: 899
5. Epidemiology
Vascular access for hemodialysis is the major risk
factor for bacteremia in patients with ESRD.
The relative risk for bacteremia in patients with
dialysis catheters is sevenfold the risk for patients
with AV fistulas.
The risk increased more than two folds if the
catheters were used in the first six months of the
HD therapy.
7. Epidemiology
The risk of BSI is higher for temporary untunneled
catheters (UTCs) compared to permanent tunneled
cuffed catheters.
Femoral catheters have the highest infection rates.
Internal jugular carries a higher rate than the
subclavian.
8. Acute Kidney Injury .
ESRD with no access.
ESRD with failure of access.
Peritoneal dialysis with complications.
Transplant patients require HD.
Plasmapharesis and Hemoperfusion.
Dialysis for overdose.
Indication of catheter
9. Temporary non Cuffed Catheters
• Short.
• More ridged.
• Easy and fast insertion.
• Immediate use.
• Higher infection rate.
• Preferred IJ or femoral.
• Avoid subclavian.
• < 3wks for IJ.
• <5 days for femoral.
Agarwal, Anil K, Asif Arif. NephSAP. Interventional Nephrology,.ASN. 361-375. 2009.
Types of catheters
10. CuffedTunneled Catheters
Dacron cuff.
Softer.
Sheath for insertion.
Different holes, length and material.
Requires sedation.
Lower neck insertion site.
◦ More bleeding.
◦ 1 year –Indefinite.
Agarwal, Anil K, Asif Arif. NephSAP. Interventional Nephrology, ASN. 361-375.2009.
Types of catheters
11. It has been shown that almost all indwelling vascular
catheters are colonized by microorganisms
These micro organisms are imbedded in a biofilm layer
and can be present 24h after insertion .
There is a link between the number of organisms retrieved
by culture from the catheter surface and the risk of
infection associated with these catheters
Infection depend on whether the organism on the catheter
surface exceed a certain quantitative threshold.
Pathogenesis
12. 1. Organisms causing bloodstream infections enter the
bloodstream from the skin insertion site or through the
hub of the catheter.
2. Skin organisms migrate from the skin insertion site along
the external surface of the catheter colonizing the distal
intravascular tip.
3. The subsequent colonization of the internal surface of
catheter cause blood stream infection.
4. Organisms may be introduced into the hub of catheter by
hands of medical personnel.
Source of infections
16. The rate of complications with Gram
positive bacteremia is nearly twofold
compared with those with Gram negative
bacteremia; Staphylococcus aureus had been
associated with most devastating metastatic
complications among HD patients owing to
its predilection to adhere to heart valves and
bone
17. Types of HD catheter infection
Localized exit site infection.
Tunnel infection.
Systemic infection.
Last access cuffed tunneled infected
catheter.
21. Pathogen related factors
Biofilm formation
Resistance to antibiotic therapy
Bacterial virulence
S. aureus nasal carriage
Contiguous infection
Hemodialysis procedure-
related factors
Contamination of dialysate or
equipment
Inadequate water treatment
Dialyzer reuse
Catheter related factors
Site of insertion
Increased duration of catheter use
History of bacteremia
Colonization of catheter tip and
cutaneous tract with skin flora
Catheter lumen contamination
Hematogenous seeding of the catheter
from anther infectious source
Contamination of the lumen with infusate
Lack of aseptic precautions during
catheter insertion
Host- related factors
Impaired host immunity
Poor personal hygiene
Occlusive dressing
S. aureus nasal carriage older age
Diabetes mellitus
Recent hospitalization
High cumulative dose of
interavenous iorn
Predisposing factors
22. Hemodialysis Catheter infection
complications
Serious complications, including infective
endocarditis, septic arthritis, septic emboli,
osteomyelitis, epidural abscess and severe
sepsis, have been reported.
S. aureus has been predominantly isolated
from those patients as a result of the
predilection of S. aureus for heart valves
and bone
23. Confirm Abx Spectrum
Remove Access
Place New Access per track
protocol
See CRBSI Algorithm
Failure to improve at 72 hours?
Progression to track infxn?
Suspected Exit site Infection
(stable patient, afebrile)
Swab Exudate for GS+ C&S
Draw BCX's
Topical Abx
+/- Systemic Abx (PO TMP/SMX vs Vanco)
Tailor Abx based on Micro
Rx usually 5-10 days
Retain Access
BCx +BCx -
Algorithm for Suspected Exit Site Infections
24. ESNTVascular Access Guidelines
We recommend application of either topical agents
or intraluminal lock solutions for the 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)
Electronic Nephrology Education: ESNT Virtual Academy
25. 48 hours appropriate abx
48 hours BCx-negative
Non-infected track tissue available
See CRBSI Algorithm
Ideal criteria for new access?
Suspected Tunnel Infection
(stable patient, afebrile)
Swab Exudate for GS+ C&S
Draw BCX's
Remove Line ASAP ( <24hours)
Establish PIV(not PICC if possible)
IV Vanco + [ tobra or ceftaz]
Tailor Abx based on Micro
Rx usually 5-10 days
BCx +BCx -
Algorithm for SuspectedTrack Infections
26. Catheter related Bacteremia
Clinical picture:
Fever with chills.
May be only during HD.
patient with Central catheter.
No other focus.
Sepsis.
Dx: Blood Cx > 15CFU. From peripheral and catheter.
Treatment:AB for 2-3 wks with exchange of the catheter
.
The catheter is the cause of fever unless proven otherwise
27. Persistent bactoromia /
fungemia and fever
Tunnel HD catheter
With suspected CRBSI
BC from catheter and peripheral vein or
bloodline if peripheral vein not feasible
Empiric vanco +
[ tobra or ceftaz]
Guidewire Exchange
after 48 hrs
Candida
albicans
Staphylococcus
aureus
Gram-
negative bacili
Coagulase-negative
staphylococcus
Guidewire CVC
exchange
Administer antifungal
therapy for 14 days
after the first negative
blood culture
Remove CVC
AND
Antibiotic x 3 wks
TEE is negative
Antibiotic 10-14days
Retain CVC, continue
antibiotic look
OR
Guidewire CVC
exchange
Antibiotic 10-14days
Retain CVC, continue
antibiotic look
OR
Guidewire CVC
exchange
Stop antibiotic
Remove CVC
Administer antibiotic
Administer
antibiotic x 4-6
wks, look for
metastatic
infections
thrombosis
endocarditis
Negative blood
cultures
Algorithm for Suspected catheter related bacteremia
(CRBSI)
28. Indications for catheter removal
Unstable patients
Bacteremia with tunnel involvement
Metastatic infection.
29. Criteria to attempt catheter salvage
Difficult to replace catheters
A hemodynamically stable patient
Blood sterile in 48–72 h
No sign of tunnel infection
No signs of metastatic infection
Microorganisms medically treatable
There is a 5-fold higher risk of treatment failure when TCC
salvage is attempted, and an 8-fold higher risk in cases
associated with S. aureus bacteraemia
Salvage should be used only as a treatment of last resort
30. Antibiotic Lock
Is indicated in reinfection with same organism.
In limited catheter sites.
Catheter Salvage is acceptable.
Onder AM, Chandar J, Simon N, Diaz R, Nwobi O, Abitbol CL, Zilleruelo G:
Nephrol Dial Transplant 23: 2604–2610, 2008.
31. ESNTVascular Access Guidelines
Guideline 5.4 – Minimizing the risk of
catheter related infection
We suggest that an antimicrobial or
antibiotic lock solution be used to reduce
catheter related bacteremia and other
infections. (2B)
Electronic Nephrology Education: ESNT Virtual Academy
32. Types of Antibiotic Lock
Cefazolin, Cephotaxim, Vancomycin, Tobramycin, Gentamyin.
Concentration: 5mg/ml.
mixed with Citrate, EDTA, Heparin, rtPA. .
Systemic AB with Antibiotic lock more effective for
◦ G. Neg.
◦ Less effective for Staph. Epidermidis.
◦ Worst for Staph aureus.
Maya ID, Carlton D, Estrada E, Allon M: Treatment of dialysis catheter-related Staphylococcus
aureus bacteremia with antibiotic lock: A quality improvement report. Am J Kidney Dis 50: 289–
295,2007
33. Conclusion
Strict follow up of infection control policy in
insertion and manipulations of dialysis
catheters .
Update the National guidelines
Dialysis Access Care program
More efforts in Patient education
AVF First