Researchers validate clinical scale for early catheter infection detection in hemodialysis
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Key takeaways:
- Researchers confirmed three early exit site signs and symptoms of catheter infection: pain, hyperemia/redness and abscess.
- The scale had an area under the receiver operating characteristic curve of 88.3%.
A clinical scale was validated for early detection of infections at the exit site of central venous catheters for hemodialysis in patients with kidney disease, according to a study.
Treating chronic kidney disease may often involve hemodialysis, José Luis Cobo-Sánchez, PhD, MSc, MBA, RN, of the Hospital Universitario Marqués de Valdecilla-IDIVAL in Santander, Spain, and colleagues wrote in study background.
“In this context, the type of vascular access employed is closely related to patient morbidity and mortality. Thus, a patient receiving [central venous catheters for hemodialysis (CVC-HD)] vs. a fistula (whether autologous or prosthetic) is at four times greater risk [for] experiencing an infectious complication, and this risk is multiplied tenfold when the sole vascular access is a CVC-HD.”
Researchers ran a multicenter prospective cohort study of data on 337 central venous catheters for hemodialysis from 310 adults receiving treatment across nine hospitals in Spain. Patients included in the EXIT site Assessment study had a tunneled central venous catheter for hemodialysis for at least 1 month after insertion.
The study produced 515 total cultures, of which 117 were infected and 398 were not.
The scale consisted of five signs and symptoms at the exit site: pain during the interdialytic period; hyperemia or erythema of at least 2 cm; inflammation, induration or swelling; fever of at least 38°C; 100.4°F not attributable to other causes; and abscess or purulent exudate.
Nurses assessed exit sites using the scale. If any relevant symptoms were present, they collected a skin swab culture from around the catheter to confirm the presence of infection.
Researchers confirmed three exit site signs and symptoms in the final version of the scale: pain between dialysis sessions; hyperemia or redness of at least 2 cm; and abscess or purulent exudate. The scale had an area under the receiver operating characteristic curve of 88.3%, with a sensitivity of 80.34% and a specificity of 95.23%.
Cobo-Sánchez and colleagues found the scale had positive predictive properties, detecting around 90% of exit-site infections with acceptable validity parameters.
“The use of this scale facilitates the early detection and treatment of exit site infection, before its microbiological confirmation,” the researchers wrote. “Furthermore, its use would improve observational objectivity by ensuring uniformity of classification, thus facilitating the comparison of results, the continuity of care, cost savings, patient education, and the comparison of research studies on measures for prevention and/or treatment.”
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