University Research: Permacath Related Infections in Dialysis Patients

This research report, submitted by a student, investigates permacath-related infections in patients undergoing dialysis. The introduction highlights the prevalence of chronic kidney disease and the use of hemodialysis, including permacaths, as a treatment. The report emphasizes the importance of the topic due to the risk of infections associated with permacath use, referencing the World Health Organization's guidelines and the specific concerns within renal departments. The methodology section details the search strategy, including keywords used in databases like PubMed and Google Scholar, and the inclusion/exclusion criteria for selecting relevant articles. A literature review analyzes several research articles, including studies on predialysis care, compliance with infection control frameworks, and the impact of permanent catheters on infection rates. The report identifies literature gaps, such as the lack of pre- and post-catheter insertion assessments and the challenges in patient scrutiny, and concludes by emphasizing the need for further research to determine the primary causes of permacath-related infections and identify effective preventive measures.

Running head: RESEARCH FOR CLINICAL PRACTICE
PERMACATH RELATED INFECTION IN PATIENTS UNDERGOING DIALYSIS
Name of the Student
Name of the University
Author note

1RESEARCH FOR CLINICAL PRACTICE
Introduction
As per the data of National Kidney Foundation (2018), more than 10 % of the world
population is currently suffering from chronic kidney disease (CKD) and within that millions of
individual lose their life because of unavailability to affordable medication. Haemodialysis is the
intervention which is used by the healthcare professionals worldwide to treat patients suffering
from CKD and are unable to go through surgery and hence, more than 1.5 million people around
the world are treated with this intervention every day (National Kidney Foundation 2018).
However, usage of haemodialysis and other similar interventions such as Permacath (a plastic
tube resembling a jugular catheter, used for dialysis purpose) can lead to bacteremia as well as
non-bacteremic infections (Tong et al. 2015). Therefore, the research topic of this assignment
will be determining the reason of permacath related infection in patients undergoing
dialysis in my dialysis unit. Further after determining the reason, several interventions will be
identified using current research articles that can prevent the emergence of permacath related
infection in the dialysis unit.
Importance of the topic
Healthcare and associated infection are major concerns for the world’s best health
organizations and for this purpose, the World Health Organization has already published a set of
guidelines including patient safety, healthcare professionals hygiene and other aspects that can
lead to severe infection inside the healthcare facility (Shafiee and Barkhordari 2013). However,
the renal department of any healthcare facility throughout the world has its own concerns and
issues related to infection control. This is because the renal department includes dialysis
interventions, which requires vascular access for a longer period of time. Zimbudzi (2012)

2RESEARCH FOR CLINICAL PRACTICE
mentions that as the number of inpatients or outpatients who are undergoing dialysis process at
the same time, the chances of blood borne microbial infection is higher in such units. There are
several facts that can be the reason of increasing infection in dialysis unit such as healthcare
facility’s infection control policies, strategies, the attitude of the staff towards self-hygiene and
maintaining nursing values so that such infection can be controlled. While determining the
relevance of this topic in current researches, the research conducted by Kitrou et al. (2017)
should be mentioned, which focuses mainly on the occurrence of bacteremia due to the usage of
short term dialysis vascular access for the permanent vascular access and insertion of permacath
tubes. Permacath tubes are a piece of plastic tubing which is used for the same purpose as
haemodialysis and has a cuff in its structure which works as a barrier to infection. However, the
number of people affected with permacath insertion related infection has been increased. More
than 18% of the Australians, undergoing haemodialysis has developed infection while catheter
insertion (Shafiee and Barkhordari 2013). Therefore, the increasing risk of infection in
permacath related dialysis requires detailed research so that the actual reason behind such
infection and the type of interventions and preventive measures can be taken against it can be
determined. The secondary reason for choosing this topic as a research topic is the increasing
number of hospital acquired infection that increases the stay of patients in the facility. Therefore,
findings from the research topic analysis can provide interventions, implementation of that can
lead to decrease the chances of infection (Chu, Adams and Crawford 2013).
Search strategy
The search strategy for this research topic included keywords such as ‘Permanent
Central venous catheters’, ‘Permacath dialysis’, ‘permacath’, ‘Hemodialysis (HD)
catheter’, ‘catheter related infection’, ‘in dialysis unit’, ‘Blood borne infection’, ‘In people

3RESEARCH FOR CLINICAL PRACTICE
admitted to dialysis unit’ were used. These keywords were searched in the databases such as,
PubMed, and Google scholar. Searching these keywords with several combinations such as
‘permacath catheter related infection in dialysis unit of healthcare facility’ generated
specific amount of search results and finally from those, research articles were segregated with
specific inclusion and exclusion criteria and after that 12 articles were selected that fulfilled the
criteria of the proposed research topic. Inclusion and exclusion criteria included usage of
permanent catheter for the dialysis purpose in the inpatient as well as outpatient service in the
observation of healthcare professionals. Different Boolean operators such as ‘And’, ‘Or’ was
used while searching for the research articles over the databases so that with several
combination, different number of results can be generated.
Literature review
In this sections, the research articles collected from the refining search strategy will be
analyzed. In e research conducted by Mahmood et al. (2013), the objective of the researchers was
to determine the effectiveness of predialysis care in the patients who are undergoing dialysis
process using permacath or other central venous catheters and also have the higher chances of
acquiring the infections. The research included 120 patients who were divided into sections, a
portion of which was given predialysis treatment and others were included for the dialysis
process directly. The result of the study determined that 39.3% of patients who were given the
dialysis treatment directly had the chances of developing bacterial infection because of the
absence of predialysis treatment and precautions. Further, in another research conducted by Chu,
Adams and Crawford (2013), the catheter related blood stream infection was assessed in five

4RESEARCH FOR CLINICAL PRACTICE
dialysis units and a nephrology ward in the healthcare facility of Australia. However, in this
setting, the researchers were determined to assess the compliance level of healthcare
professionals with the Australian practice development framework and using those strategies
mentioned in the framework in reducing the number of blood borne infections in patients
undergoing dialysis (Nesrallah et al. 2016). This research article mostly focused on hygiene and
structural factors if the dialysis unit in preventing the infection related to permanent catheter or
permacath among the patients of chosen healthcare facility. The third literature which was
analyzed to determine the effect of permanent catheter on the patients, who were at high risk of
bacteremia (Fülöp et al. 2017). For this purpose, the researchers inserted permanent catheter in
all the 101 patients and then provided them with 21 day course of intravenous antibiotic. For
identification of catheter associated bacteremia or CAB, the patients were assessed for blood
culture, episodes of bacteremia and the type of intervention applied. Further, the results indicated
that only 11 patients did not shown any sign of infection whereas 84 patients developed infection
due to the action of bacteria such as gram positive bacteria or staphylococcus aureus and gram
negative bacteria (Szerlip et al. 2016). Therefore, the findings from this research identified that
due to the direct contact with the blood stream, insertion of parmacath tubing or catheters
increases the chances of infection in people undergoing dialysis. However, in an another research
study by Wang et al. (2015) indicated towards the fact that conditions such as
arteriovenous fistula and insertion of arteriovenous grafts are also in direct contact with the
blood stream however, the rate of infection in patients with permanent catheter was ten times
higher than that of the arteriovenous grafts or arteriovenous fistula. This is because the direct
access of blood stream though permanent catheters was more than that of the arteriovenous grafts
or fistula that leads the patient to severe infection (Vats 2012).

5RESEARCH FOR CLINICAL PRACTICE
However, the abovementioned literatures had their limitations and the present literature
gap should be addressed to provide a concise about the interventions that should be applied to
decrease the chance of infection due to the insertion of permacath tubes in patients approaching
dialysis. The research conducted by Mahmood et al. (2013) was dependent on the convenient
sample size and also included only the outpatient services whereas, the number of infections in
inpatients going through dialysis is more than that of the outpatient service. On the other hand,
on the other hand, the research conducted in the healthcare setting of Australia and the literature
gap of including the practice after the insertion of catheter. The researcher should have been
included process prior to catheter insertion as it would have provided proper assessment related
to the practice of nurses in dialysis unit. Therefore, the research gap of this literature was absence
of pre and post insertion of catheter related results that affected the authentication of the results.
In the third research conducted by Chu, Adams and Crawford (2013), the scrutiny of patients not
possible as maximum of them were discharged from the healthcare facility and were provided a
date of reporting, due to which, the authentication of the research hampered as identification of
source of infection becomes difficult (Fülöp et al. 2017). These were the literature gaps present
in the above-mentioned research articles. therefore, my research will be centered around the
identification of primary reason of permacath related infections in dialysis unit as well as will be
targeted to identify the interventions using which, such infection can be prevented.
Conclusion
As the number of people affected with catheter related or permanent catheter related
infection are increasing, researches concerning about the reason of such infection should be
conducted with infection so that preventive measures can be taken. In this assignment, this
research topic was selected and a search strategy was also provided using which supporting

6RESEARCH FOR CLINICAL PRACTICE
researches were collected from multiple databases. Further, using the selected research articles, a
literature review was conducted.

7RESEARCH FOR CLINICAL PRACTICE
References
Chu, G., Adams, K. and Crawford, S., 2013. Improving catheter-related blood stream infection in
haemodialysis patients using a practice development framework. Renal Society
Australasia J, 9(1), pp.16-21.
Fülöp, T., Tapolyai, M.B., Agarwal, M., Lopez‐Ruiz, A., Molnar, M.Z. and Dossabhoy, N.R.,
2017. Bedside Tunneled Dialysis Catheter Removal—A Lesson Learned From
Nephrology Trainees. Artificial organs, 41(9), pp.810-817.
Kitrou, P.M., Papadimatos, P., Katsanos, K., Spiliopoulos, S., Christeas, N., Petsas, T. and
Karnabatidis, D., 2017. Managing the Failing Dialysis Permacath: Results from a 5-year
Retrospective Analysis. Hellenic Journal οf Radiology, 2(3).
Mahmood, S.N., Mukhtar, K.N., Iqbal, N. and Umair, S.F., 2013. Pre dialysis care and types of
vascular access employed in incident hemodialysis patients: A study from
Pakistan. Pakistan journal of medical sciences, 29(3), p.828.
National Kidney Foundation 2018. GLOBAL FACTS: ABOUT KIDNEY DISEASE. Accessed on
August 1, 2018. Retrieved from: https://www.kidney.org/kidneydisease/global-facts-
about-kidney-disease
Nesrallah, G.E., Mustafa, R.A., MacRae, J., Pauly, R.P., Perkins, D.N., Gangji, A., Rioux, J.P.,
Steele, A., Suri, R.S., Chan, C.T. and Copland, M., 2013. Canadian Society of
Nephrology guidelines for the management of patients with ESRD treated with intensive
hemodialysis. American Journal of Kidney Diseases, 62(1), pp.187-198.

8RESEARCH FOR CLINICAL PRACTICE
Shafiee, A. and Barkhordari, K., 2013. Another side effect of subclavian catheter. Iranian
journal of kidney diseases, 7(2), p.101.
Szerlip, M., Kim, R.J., Adeniyi, T., Thourani, V., Babaliaros, V., Bavaria, J., Herrmann, H.C.,
Anwaruddin, S., Makkar, R., Chakravarty, T. and Rovin, J., 2016. The outcomes of
transcatheter aortic valve replacement in a cohort of patients with end‐stage renal
disease. Catheterization and Cardiovascular Interventions, 87(7), pp.1314-1321.
Tong, S.Y., Davis, J.S., Eichenberger, E., Holland, T.L. and Fowler, V.G., 2015. Staphylococcus
aureus infections: epidemiology, pathophysiology, clinical manifestations, and
management. Clinical microbiology reviews, 28(3), pp.603-661.
Vats, H.S., 2012. Complications of catheters: tunneled and nontunneled. Advances in chronic
kidney disease, 19(3), pp.188-194.
Wang, K., Wang, P., Liang, X., Lu, X. and Liu, Z., 2015. Epidemiology of haemodialysis
catheter complications: a survey of 865 dialysis patients from 14 haemodialysis centres in
Henan province in China. BMJ open, 5(11), p.e007136.
Zimbudzi, E., 2012. Suitability of chlorhexidine impregnated dressings on dialysis catheters in
an acute dialysis setting: Lessons from our experience. International Journal of Infection
Control, 8(3).