Survey of Skin Antiseptic Solutions for Vascular Access in Hemodialysis Patients in Japan: Types and Reasons for Selection

Abstract

  This study investigated the types of skin antiseptic solution used for vascular access (VA) in hemodialysis patients and the reasons for selection. Seven hundred health-care facilities were randomly selected from the total of 3,827 hemodialysis centers in Japan, and a self-completed questionnaire was mailed to the chief nurses of the selected health-care facilities to conduct an anonymous survey. Three hundred and twenty-six facilities returned the questionnaires (46.5% response rate), and the answers from 323 facilities were analyzed (99.1%). Usage of ethanol was high in patients with arteriovenous fistulas (38.1%), and povidone-iodine was used for many cases of all VA types except arteriovenous fistulas (arteriovenous grafts 74.8%; superficial arteries 72.1%; short-term VA catheters 72.0%; long-term VA catheters 65.8%). Usage of chlorhexidine gluconate-ethanol was 18.4% for short-term VA catheters and 21.8% for long-term VA catheters. In a few cases, weakly and strongly acidic water were used for arteriovenous fistulas, physiological saline (normal saline) for short-term VA catheters, and physiological saline (normal saline) or tap water for long-term VA catheters. The reason for choosing the antiseptic solution was significantly related to the first choice of antiseptic solution for all five VA types. Knowledge regarding the skin antiseptic solutions in the Centers for Disease Control and Prevention guidelines was significantly related to the first choice of antiseptic solution for short- and long-term VA catheters. This study found many types of skin antiseptic solutions were used for all five VA types. More solid evidence for correct selection of the optimum skin antiseptic solutions for each of the VA types is needed.