As patients with hemodialysis catheters shower against instruction, researchers call for new protocols
DALLAS — While patients on hemodialysis are often instructed to avoid showering or bathing with catheters, many patients do so anyway and products designed to protect against water exposure can be expensive, according to results of a poster presented at the Annual Dialysis Conference. Therefore, researchers suggested a specific protocol for showering with catheters should be developed.
“The Centers for Disease Control and Prevention recommends that showering be allowed if the catheter is protected,” Rachel Snyder, MPH, of the CDC in Atlanta, and colleagues wrote. “We aimed to understand current literature on this topic and options available to protect hemodialysis central venous catheters from water exposure.”
Researchers conducted a web search for products designed to protect central venous catheter sites from water exposure and contacted product manufacturers to determine cost, materials and product use. Assuming patients showered daily, the estimated cost of use was calculated for 1 month and 3 months.
Researchers also conducted a systematic literature review of articles related to showering or swimming of patients with central venous catheters and identified four studies related to patient perception/practices and seven studies that evaluated shower interventions.
Researchers found that, in two studies, interventions to protect catheter hubs from water exposure resulted in decreased bloodstream infection rates. In three other studies that examined showering protocols with and without catheter hub protection, followed by chlorhexidine after showering, researchers found no significant difference in rates of infection between the showering and non-showering groups.
Regarding 1-month product costs, researchers found that sheet products ranged from $44.95 to $139.20, a pouch product was $79.99 and the one-time cost for reusable cape products ranged from $44.95 to $65.
Researchers concluded that evidence is limited as to whether showering with a protocol that includes catheter hub protection can decrease bloodstream infection risk and data supporting other elements of shower protocols, like post-shower exit site care or specific products, are insufficient.
“Products designed to prevent water contamination of catheters during showering are available but might be cost-prohibitive,” the researchers wrote. “A feasible, best-practice for showering with a hemodialysis catheter is needed.” – by Melissa J. Webb
Snyder R, et al. Showering in hemodialysis catheter patients: Risk of infection and catheter protection products. Presented at the Annual Dialysis Conference; March 16-19, 2019; Dallas.
Disclosures: Healio/Nephrology was unable to confirm relevant financial disclosures prior to publication.