Early identification of local infections in central venous catheters for hemodialysis: A systematic review

Cobo-Sánchez, José Luis; Blanco-Mavillard, Ian; Mancebo-Salas, Noeia; Moya-Mier, Susana; González-Menéndez, Faustino; Renedo-González, Cristina; Lázaro-Otero, Mercedes; Alonso, Raquel Pelayo; González, Zulema Gancedo; Pedro-Gómez, Joan Ernest de

doi:10.1016/j.jiph.2023.04.012

Cited by 3 publications

(6 citation statements)

References 55 publications

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“…In addition, our study allowed consensus on the definition of ESI as the presence of pain at ES during the interdialysis period, with fever ≥38°C do not suspect other causes, local signs at the ES (inflammation, induration, swelling, hyperemia/erythema ≥2 cm from the ES) and obvious abscess or purulent exudate at the ES. In general, most of these signs/symptoms coincide with those most frequently identified in the previous systematic review (Cobo-Sánchez et al, 2023).…”

Section: Discussionsupporting

confidence: 76%

“…Harwood et al found that signs/symptoms that correlated statistically significantly were erythema of less than 5 mm around the ES (p = 0.008), whereas most infected ESs showed erythema between 1 and 1.5 cm in diameter from the ES (Harwood et al, 2008). In the review of Cobo-Sánchez et al the majority of the documents included in it used a diameter ≥2 cm for erythema, induration and tenderness (Cobo-Sánchez et al, 2023). Erythema was the main sign found by Bouza et al in ESIs (12%) together with purulent discharge (7.1%) (Bouza et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

“…A recent systematic review shows a showed a high heterogeneity in the signs and symptoms used for determining ESI and tunnel infection (TI) in HD-CVC (Cobo-Sánchez et al, 2023). Given this conceptual variability, it is essential to reach a consensus on what are the unequivocal signs and symptoms that may lead to the suspicion of the presence of an ESI.…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…The research team identified a list of signs and symptoms related to ES or HD-CVC TI from the definitions of this dimension identified in a previous literature review (Cobo-Sánchez et al, 2023).…”

Section: Development Of Questions For Each Itemmentioning

confidence: 99%

“…This review included a manual review of seven relevant clinical practice guidelines on haemodialysis vascular access care and infection control, in addition to 40 documents from automated searches in different databases, identifying 25 signs/symptoms (Cobo-Sánchez et al, 2023). Once this list of predictors of ESI and/ or TI in tunnelled HD-CVC was compiled, the research team carried out a critical analysis and a final list of 22 signs/symptoms was drafted, resulting in the items to be assessed by the expert panel (see Table 1).…”

Section: Development Of Questions For Each Itemmentioning

confidence: 99%

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Definition and clinical management of haemodialysis central venous catheter local infections (exit site and tunnel infection): An international consensus assessment

Cobo‐Sánchez,

Blanco‐Mavillard,

Mancebo‐Salas

et al. 2023

Journal of Clinical Nursing

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AimTo evaluate the relevance of signs and symptoms for the clinical identification of ESI and TI in HD‐CVC, by means of international expert consensus, and to reach a consensus on a definition and clinical management (CM) for these infections.BackgroundA recent systematic review showed a high heterogeneity in the signs/symptoms used for determining exit site infection (ESI) and tunnel infection (TI) of haemodialysis central venous catheter (HD‐CVC).DesignA modified Delphi ranking process was carried out between November 2020 and March 2021, consisting of four rounds using an online questionnaire with a panel of 26 experts from 12 countries.MethodsExperts responded on the level of relevance for the identification of ESI and TI, based on a list of 22 signs/symptoms obtained from a previous systematic review, using a 4‐point Likert‐type scale. After reaching consensus on the signs/symptoms, they followed the same method to reach consensus on the CM. The STROBE Checklist was used to report this study.ResultsA high degree of consensus was reached to identify the presence of ESI based on nine signs/symptoms: presence of pain at the exit site (ES) during interdialysis period, with fever ≥38°C do not suspect other cause, local signs at the ES (inflammation, induration, swelling, hyperemia/erythema ≥2 cm from ES) and obvious abscess or purulent exudate at ES; and of TI. Likewise, 5 cm were agreed upon.ConclusionThis Delphi study provides international expert consensus definitions of ESI and TI in HD‐CVC, laying the groundwork for the validation of an HD‐CVC ES clinical assessment scale for early identification of ESI.Relevance to Clinical PracticeIn addition, this study provides a series of attitudes to consensual clinics regarding signs/symptoms of local infections in HD‐CVC, which may be useful as expert opinion in clinical practice guidelines, when there is insufficient scientific evidence.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Backg Rou N Dmentioning

confidence: 99%

Section: Development Of Questions For Each Itemmentioning

confidence: 99%

Section: Development Of Questions For Each Itemmentioning

confidence: 99%

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