Haemodialysis antimicrobial barrier caps (ClearGuard)
Topic Status Complete
Antimicrobial barrier caps for use with haemodialysis catheter hubs to reduce catheter-related bloodstream infections.
Outcome of the appraisal
The evidence supports the routine adoption of ClearGuard HD antimicrobial barrier caps for use with haemodialysis catheter hubs.
Clinical evidence shows that the use of ClearGuard HD caps reduce the rate of blood stream infections compared to standard caps. Economic modelling suggests that the use of ClearGuard HD has the potential to lead to overall cost savings.
Health Technology Wales recommends the collection of real world audit data around the use of ClearGuard HD caps in Wales.
Why was this topic appraised?
Chronic kidney disease is usually mild in severity, but in some cases can progress to end-stage renal failure. Haemodialysis is the most common treatment option for people who develop end-stage kidney disease. Although most patients requiring haemodialysis have an arterio-venous fistula created to allow access to the circulation, some patients need to be dialysed through a central venous catheter (CVC) that is placed in a large vein in the chest. Because the dialysis circuit needs to be connected and disconnected from the CVC regularly, there is a risk of blood stream infections (BSIs) which can be serious and lead to hospitalisation, mortality and increased healthcare costs.
ClearGuard HD antimicrobial barrier caps, which incorporate an anti-septic, are screwed on to the end of a catheter hub after haemodialysis has finished and are designed to prevent catheter-introduced BSIs.
HTW identified this topic through HealthTechConnect.
Plain language summary
Chronic kidney disease (CKD) is a condition where the kidneys don’t work as they should. It is often associated with getting older and is long-term. In some cases, chronic kidney disease can progress and develop into end-stage kidney disease, which is where kidney function has declined to the point that the kidneys can no longer function on their own. The most common treatment option for people who develop end-stage kidney disease is a process called haemodialysis. This is where blood from the body is put through a machine that cleans the blood by filtering waste from it before it is returned to the patient’s body, doing the job that the patient’s kidneys can no longer do.
Blood is drawn for this procedure using a central venous catheter (CVC). This is a thin, flexible medical tubing. The CVC is inserted into a large vein and blood from the vein travels through the CVC into the haemodialysis machine and then back into the body once cleaned. Despite the use of lots of different ways to keep CVCs clean, CVC-use for haemodialysis can lead to blood stream infections (BSIs), which can lead to longer stays in hospital and in some cases death.
Antimicrobial barrier caps are screwed on to the end of a CVC at the final stage of the haemodialysis process and are designed to prevent such an infection from occurring.
HTW looked for evidence that antimicrobial barrier caps can be effectively used with haemodialysis CVCs in reducing catheter-related bloodstream infections.
The evidence supports the routine adoption of ClearGuard HD antimicrobial barrier caps for use with haemodialysis catheter hubs
Topic Exploration Report
Evidence Appraisal Review