Success! Facilitating Choice for Renal Patients in The Tropics With Central Venous Lines to Maintain The Integrity of Their Dressings While Attending to Personal Hygiene: A Multi-Phase Study

Aim: To explore individual patients’ choices in personal hygiene, while maintaining the integrity of catheter exit site dressings between dialysis sessions. Background: For patients undergoing haemodialysis via a central venous catheter (CVC), infection is a major life-limiting risk. Meticulous attention to keeping the exit site dressing clean and dry is an essential defence in preventing infections. It is difficult to maintain the integrity of water-resistant dressings in tropical environments. Design: A three-phase exploratory study was conducted in a northern Australian Renal Service. Methods: Phase One employed a cross-sectional survey of nurses on the acceptability and feasibility of two hygiene options: bathing wipes and a waterproof dressing cover. Phase Two used conversational-style interviews with patients about their hygiene preferences, how they endeavoured to keep their dressings dry, and impressions regarding the provided options. Phase Three was a series of case studies of patients trialling the provided options. The STROBE checklist was used. Results: Phase 1: Nurses (n=37) considered both options acceptable and feasible, noting some practical concerns related to their use.Phase 2: Patients (n=27) described hygiene preferences and difficulties they encountered with keeping dressings dry. They were enthusiastic about trying the proposed options. Phase 3: Patients (n=22) appreciated being able to shower without wetting their exit site dressings. Individuals were inventive in modifying the application and use of the waterproof cover according to their body shape and exit site location. Although participants liked both options, the waterproof covering was most popular and most frequently used. Intactness of the dressings was 83% during the trial; there were no CVC-associated infections during the study. Conclusion: Assisting patients keep their dressings dry and intact during personal hygiene in a tropical environment promoted dignity and autonomy. Implications for clinical practice Patients demonstrated their willingness to undertake a more active role in their dressing care.