Dialysis filters waste products and excess fluids from the blood when kidneys are no longer able to perform this function effectively. While life-sustaining, dialysis introduces a pathway for infections, a common and serious complication. Understanding these infections, their symptoms, prevention, and treatment is important for patient safety.
Infection Risk in Dialysis
Dialysis patients face an elevated infection risk due to weakened immune systems and regular access to their bloodstream or abdominal cavity. Hemodialysis and peritoneal dialysis each present specific infection pathways.
Hemodialysis involves filtering blood through an external machine, requiring a vascular access point. These access sites (catheters, arteriovenous fistulas, or grafts) are direct entry points for bacteria. Catheter-related bloodstream infections are a common concern, with central venous catheters posing a higher risk than fistulas or grafts. Infections can arise from bacteria on the skin around the access site, contamination of equipment, or insufficient hygiene during the dialysis procedure.
Peritoneal dialysis utilizes the lining of the abdomen (peritoneum) as a natural filter. A catheter is surgically placed in the abdomen for the exchange of a cleansing fluid called dialysate. The main infection concern is peritonitis, an inflammation of the peritoneum, typically caused by bacterial or fungal infection. Contamination during the fluid exchange process, such as touching the catheter cap with unwashed hands, or issues with the catheter exit site, can introduce pathogens. Obesity, use of immunosuppressive drugs, and loss of residual kidney function can increase the risk of peritonitis.
Recognizing Infection Symptoms
Prompt identification of infection symptoms is important for dialysis patients to ensure timely medical intervention. General signs of infection include fever, chills, fatigue, or body aches. These systemic symptoms often indicate the body’s response to an invading pathogen.
For hemodialysis patients, specific signs at the vascular access site warrant immediate attention. These localized symptoms include redness, swelling, increased warmth, pain, or pus/unusual drainage. Checking the access site daily for any of these changes is a recommended practice.
Peritoneal dialysis patients should be aware of distinct symptoms indicating peritonitis. A key indicator is cloudy peritoneal fluid, which is typically clear. Other symptoms include abdominal pain, tenderness, bloating, nausea, vomiting, and fever. Any of these symptoms should prompt immediate contact with a healthcare provider.
Preventing Infections
Preventing infections in dialysis patients involves a multi-faceted approach, with significant roles for both patients and healthcare providers. Strict adherence to hand hygiene is foundational. Patients should wash their hands or use an alcohol-based hand sanitizer before and after touching their access site.
Proper care of the access site is important. This includes keeping the area clean and dry, performing dressing changes as instructed, and avoiding unnecessary contact with the catheter, fistula, or graft. Patients should protect their access site during showers and avoid public pools or hot tubs. For peritoneal dialysis, wearing a mask during exchanges and applying antibiotic cream to the catheter exit site as prescribed can help reduce infection risk.
Healthcare providers employ sterile techniques during all dialysis procedures. This includes using appropriate personal protective equipment (PPE) like gowns, gloves, and face protection, and practicing safe injection methods. Regular training for staff on infection control practices, along with thorough cleaning and disinfection of dialysis machines and environmental surfaces, helps minimize germ transmission.
Treating Infections
Treating dialysis-related infections typically involves antibiotics. These medications are often administered intravenously. The specific antibiotic chosen depends on the type of bacteria causing the infection, which is usually identified through laboratory tests. For instance, vancomycin is frequently used for Gram-positive bacterial coverage.
Management of the dialysis access site is also a consideration. If an infection is severe or persistent, particularly with a central venous catheter, removal or replacement of the catheter may be necessary. For arteriovenous fistulas or grafts, localized treatments or surgical interventions might be required. In cases of peritonitis, antibiotics are often administered directly into the peritoneal cavity through the dialysis catheter.
Timely diagnosis and treatment are important to prevent complications such as sepsis, a life-threatening response to infection that can lead to organ dysfunction. Early intervention also helps preserve the functionality of the dialysis access for ongoing treatment. In some instances, a temporary switch to a different type of dialysis may be needed while the body recovers from the infection.