HHE Standards of care in haemodialysis catheters - Page 4

4 | STANDARDS OF CARE IN HAEMODIALYSIS CATHETERS | 2021
My one unit , which treats between 65 and 80 patients , went to zero infections for 18 months after switching to ClearGuard Connie Jo Hemeyer
In Germany , the ‘ Fistula First ’ policy , which favours AVF in all cases , has been replaced with the Vascular Access Life Plan , which aims to consider patients ’ preferences and expectations . This highlights a possible progression into a more patient-guided approach when deciding between methods .
The COVID-19 pandemic is also an influential factor in CVC preference , as the high burden on healthcare systems leads to patients presenting later , often requiring the immediate haemodialysis that CVC can provide . Closure of dialysis clinics due to COVID-19 and reduced availability of specialist staff , anesthetists , and operating rooms required for AVF also favours CVCs .
These factors now see CVC being used in 30 % to 50 % of patients , which calls for intervention to reduce CVC-related complications , particularly in elderly or comorbid patients receiving end-of-life care .
Evidence to support implementation of ClearGuard TM HD Unlike standard end caps , ClearGuard TM HD antimicrobial barrier caps aim to reduce rates of CLABSIs using a chlorhexidine acetate coating . This mechanism was tested across three studies with large cohorts , spanning many centres across the USA . All three studies confirmed a significant reduction in CLABSI rates , shown in box 2 .
The first study , published in the American Journal of Kidney Disease , compared blood cultures in patients using ClearGuard HD with those using a standard end cap . A 56 % reduction in CLABSI rate was observed over a 12-month period when using ClearGuard HD , with the last 6 months of intervention being associated with a 69 % reduction .
The second study , published in the Journal of the American Society of Nephrology , compared ClearGuard HD with combined Tego ® Needlefree
BOX 2
Summary of three studies comparing ClearGuard HD with alternative technologies
Hymes JL , Mooney A , Van Zandt C , Lynch l , et al . Am J Kidney Dis 2017 ; 69:220 – 7
Devices ClearGuard HD vs . Standard HD cap
Brunelli SM , Van Wyck DB , Njord L , Ziebol RJ , et al . J Am Soc Nephrol 2018 ; 29:1336 – 43
ClearGuard HD vs . Tego plus Curos
Weiss S , Qureshi M . Int J Neph Renovasc Dis 2021 ; 14:125 – 32
ClearGuard vs . Tego
CLABSIs / 1000 CVC days
. 26 treatment | . 59 control
. 28 treatment | . 75 control
. 09 treatment | . 63 control
CLABSIs reduction (%)
56 % Full Study | 69 % Last 6 Months
63 % 86 %