Smyth, Wendy, McArdle, Joleen, Wicking, Kristin, Quayle, Kimberley, and Nagle, Cate (2022) Facilitating personal hygiene choices for renal patients with central venous lines: a multi-phase study. Australian Journal of Advanced Nursing, 39 (3). pp. 24-32.

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Abstract

This study explored personal hygiene options of renal patients that maintain the integrity of central venous catheter exit site dressings between dialysis sessions.

Background: Infection is a major life-limiting risk for patients undergoing haemodialysis via a central venous catheter. Meticulous attention to keeping the exit site dressings clean and dry is an essential defence in preventing local and systemic infections. It is difficult to maintain the integrity of water-resistant dressings in tropical environments.

Study Design: A three-phase exploratory study was conducted in a northern Australian Renal Service.

Methods: Phase 1 employed a cross-sectional, anonymous, online survey of renal nurses about the acceptability and feasibility of two hygiene options for patients: bathing wipes and a waterproof dressing cover. The survey also canvassed their concerns about the options. Descriptive statistics were used to summarise Likert-scale responses and content analysis was used for responses to open-ended survey questions. Phase 2 used conversational-style interviews with patients about their hygiene preferences, how they endeavoured to keep their dressings dry, and their impressions regarding the proposed options. Phase 3 was a series of case studies of patients trialling the provided options over a six-week period. Participants were progressively recruited to this phase and were provided with the product/s of their choice at each dialysis session; renal nurses also assessed the integrity of the dressings at each dialysis session. Research nurses discussed with the participants their experiences with the options.

Results: Phase 1: Nurses (N=37, response rate 58.7%) considered both options acceptable and feasible for patients, noting some practical concerns related to their use. Phase 2: Patients (N=27, 100% participation rate) described hygiene preferences and difficulties they encountered with keeping dressings dry. Only one participant had a bath, as per written advice. All 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 the central venous catheter 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 central venous catheter-associated infections during the study.

Conclusion: Self-management and choice were motivating factors for participants. Patients embraced being able to keep their dressings dry and intact during personal hygiene in a tropical environment.

Implications for research, policy, and practice: Patients demonstrated their willingness to undertake a more active role in their dressing care, while exercising choice with respect to personal hygiene. Studies that further increase patients’ participation in other aspects of their self-care warrant further investigation. The organisation is pursuing options for the ongoing provision of the products used in this study and how their use can be monitored in clinical practice.

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