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

Abstract

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.