Autori: Matthias Zeiler (1), Katia Monteverdi (1), Alessandro Tantucci (1), Cinzia Casci (1), Lorena Sbarbati (1), Stefano Santarelli (1)
Affiliazioni: (1) U.O. Nefrologia e Dialisi, Ospedale “Carlo Urbani”, Jesi (AN)
Background:
Silver medications seem to be helpful protecting from exit site infection in haemodialysis and peritoneal dialysis. Early stages of exit site infection might be treated locally with a silver medication without antibiotic therapy.
Objectives:
The aim of the study was to analyze the effect of a silver medication at the button hole incannulation site of haemodialysis patients and at the exit site of peritoneal dialysis patients site measured by macrophotography.
Methods:
The button hole incannulation site in 18 haemodialysis patients was evalutated by macrophotography. Clinical signs of local infection of the puncture site had to be absent for at least three months. The macrophotographic aspect utilizing a standard fistula compression bandage (Betafix, Emodial, Italy) was compared to the corresponding containing a silver pad (Nuova Betafix AG Silver, Emodial, Italy).
For each type of medication a set of macrophotographic images after four consecutive dialysis sessions was performed in all patients.
Utilizing the same photographic technique the exit site of 5 peritoneal dialysis patients without signs of exit site infection was evaluated. The exit site medication was changed every second day utilizing at first a standard medication kit and consecutively a silver medication (Exit Pad AG Silver, Emodial, Italy).
The macrophotographic images were analyzed in a blinded manner confronting pairwise the images of same patient. Image criteria were local erythema and oedema. A graduation, reduction-unchanged-increase, was applied for each criteria.
Results:
The silver medication was well tolerated in both groups. The button hole incannulation site presented a minor extend of local erythema and edema during silver medication (erythema: reduction in 55.6%, unchanged in 36,1%; oedema: reduction in 38.9%, unchanged in 58.3%). The same tendency of erythema and oedema reduction was evidenced at the exit site of the five peritoneal dialysis patients. There were no local infections during the observation period.
Conclusion:
The use of a fistula compression bandage containing a silver pad resulted in a reduction of local inflammatory signs at the button hole incannulation site of haemodialysis patients and at the exit site of peritoneal dialysis patients, apparently due to the local antibacterial action of silver.
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