HHE Standards of care in haemodialysis catheters - Page 5

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I have several patients with aged up to 90 years on regular haemodialysis with catheters . This will help . So , this is a nice story with very nice results , but in Europe we need a study Mario Cozzolino
I was always wondering why we are not using any safety caps in central venous catheters . So , using a cap , like the ClearGuard , which allows a clear-cut reduction of infections , makes complete sense as each single infection is one too many Martin Kuhlmann
Connectors and Curos TM Disinfection Caps . Over the 13-month study , ClearGuard HD was associated with a 63 % lower CLABSI rate .
The final study , published in the International Journal of Nephrology and Renovascular Disease , compared ClearGuard HD with Tego retrospectively , observing 0.09 / 1000 CVC days and 0.63 / 1000 CVC days , respectively . This confirmed an infection rate of less than one CLABSI incident every 1000 days , showing an 83 % decrease when compared to Tego .
Translating research findings into real-world applications . The efficacy of ClearGuard HD for reducing CLABSIs in a clinical setting has been confirmed , but how does this translate to patient journeys and hospital settings in the real-world ?
Overall , healthcare professionals are convinced by the compelling nature of the study findings ; however , the general conjecture highlighted a need to gain additional evidence in a European setting , as the ability to extrapolate results obtained from centres across the USA is questionable . This mainly relates to saline locks being most commonly used in the USA , while , in Europe , 4 % citrate and heparin locks are preferred ; as citrate locks already have some antibacterial properties , the efficacy of ClearGuard HD combined with these should be specifically observed .
HCPs addressed the cost of ClearGuard HD caps , concluding that it is offset by the alternative higher financial burden of CLABSIs on both hospitals and patients . The lower cost is likely to be reflective of a reduction in antibiotic demand , which was observed in the studies despite not being a defined endpoint . This , as well as the antimicrobial properties of ClearGuard HD caps , lessens fear surrounding antibacterial resistance . Yet , as the prevalence of CLABSIs is lower in Europe than the USA , the demand for CVCs and the economic value of ClearGuard HD , combined
BOX 3
What awaits ClearGuard HD in the future ?
Lock solution guidelines
ClearGuard HD in homecare
Future research : European
studies
• The incongruence of lock solution choice between Europe and the USA highlights a need to develop a universal set of guidelines .
• Particularly for lock solutions accompanying Clear Guard HD , as HCPs emphasised the need for instruction .
• An increase of HD in homecare , particularly in France , will likely increase need for CVCs .
• The ease of use that comes with ClearGuard HD appeals to HCPs for implementation into the home setting .
with 4 % citrate locks , should be confirmed to justify its use in this market .
It was agreed amongst the delegates that ClearGuard HD alone would not increase their tendency to use CVCs in general . Nevertheless , they emphasised its importance in reducing the rates of CLABSIs for elderly or comorbid patients receiving end-of-life care , and to meet the greater need for immediate dialysis in a post-COVID-19 society .
Summarising key messages for ClearGuard HD caps
• Despite lower incidences of infections and complications with AVF or graft , CVC usage is increasing with numbers as high as 50 % of patients .
• This increase is likely to be a result of the ageing population prioritising quality of life – particularly in end-of-life care – and a greater emphasis on patient preference . COVID-19 increased the demand for immediate dialysis via CVC , due to patients presenting later and leaving less time for AVF creation .
• Due to high rates of CLABSIs associated with CVC , incurring large infection-related costs , this highlights an unmet need of improved safety and decreased financial burden on healthcare systems and patients .
• ClearGuard HD was tested across three studies and was shown to elicit significantly lower rates of CLABSIs compared to standard HD caps in the first study , Tego plus Curos in the second , and finally Tego alone . CLABSI rates were decreased by 56 % to 69 %, 63 %, and 86 %, respectively .
• HCPs concurred that the cost of ClearGuard HD is offset by the alternative higher financial burden of CLABSIs on both hospitals and patients .
• The incongruence of lock solutions between the USA and Europe not only highlights a need for research confirming the efficacy of ClearGuard HD with 4 % citrate solution , but emphasises the need to develop universal guidelines for choosing lock solutions .
• Assess efficacy of ClearGuard HD with citrate and heparin locks , compared to either alone .
• Investigate trends within centers using their usual lock solution , to identify subgroups of patients and determine superior solutions .