{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T03:54:55Z","timestamp":1761710095846,"version":"3.40.5"},"reference-count":41,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,12,13]],"date-time":"2023-12-13T00:00:00Z","timestamp":1702425600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Clinical Nursing"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>To evaluate the relevance of signs and symptoms for the clinical identification of ESI and TI in HD\u2010CVC, by means of international expert consensus, and to reach a consensus on a definition and clinical management (CM) for these infections.<\/jats:p><\/jats:sec><jats:sec><jats:title>Background<\/jats:title><jats:p>A recent systematic review showed a high heterogeneity in the signs\/symptoms used for determining exit site infection (ESI) and tunnel infection (TI) of haemodialysis central venous catheter (HD\u2010CVC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A modified Delphi ranking process was carried out between November 2020 and March 2021, consisting of four rounds using an online questionnaire with a panel of 26 experts from 12 countries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Experts responded on the level of relevance for the identification of ESI and TI, based on a list of 22 signs\/symptoms obtained from a previous systematic review, using a 4\u2010point Likert\u2010type scale. After reaching consensus on the signs\/symptoms, they followed the same method to reach consensus on the CM. The STROBE Checklist was used to report this study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A high degree of consensus was reached to identify the presence of ESI based on nine signs\/symptoms: presence of pain at the exit site (ES) during interdialysis period, with fever \u226538\u00b0C do not suspect other cause, local signs at the ES (inflammation, induration, swelling, hyperemia\/erythema \u22652\u2009cm from ES) and obvious abscess or purulent exudate at ES; and of TI. Likewise, 5\u2009cm were agreed upon.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This Delphi study provides international expert consensus definitions of ESI and TI in HD\u2010CVC, laying the groundwork for the validation of an HD\u2010CVC ES clinical assessment scale for early identification of ESI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Relevance to Clinical Practice<\/jats:title><jats:p>In addition, this study provides a series of attitudes to consensual clinics regarding signs\/symptoms of local infections in HD\u2010CVC, which may be useful as expert opinion in clinical practice guidelines, when there is insufficient scientific evidence.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jocn.16941","type":"journal-article","created":{"date-parts":[[2023,12,14]],"date-time":"2023-12-14T09:49:25Z","timestamp":1702547365000},"page":"559-571","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Definition and clinical management of haemodialysis central venous catheter local infections (exit site and tunnel infection): An international consensus assessment"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3695-9216","authenticated-orcid":false,"given":"Jos\u00e9 Luis","family":"Cobo\u2010S\u00e1nchez","sequence":"first","affiliation":[{"name":"Hospital Universitario Marqu\u00e9s de Valdecilla\u2010IDIVAL  Santander Spain"},{"name":"Immunopathology Research Group Marqu\u00e9s de Valdecilla Institute for Health Research (IDIVAL)  Santander Spain"},{"name":"University Nursing School Hospital Momp\u00eda, Universidad Cat\u00f3lica de \u00c1vila  Momp\u00eda Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2851-5631","authenticated-orcid":false,"given":"Ian","family":"Blanco\u2010Mavillard","sequence":"additional","affiliation":[{"name":"Implementation, Research, and Innovation Unit Hospital de Manacor  Manacor Spain"},{"name":"Department of Nursing and Physiotherapy Universitat de les Illes Balears  Palma Spain"},{"name":"Care, Chronicity and Evidence in Health Research Group (CurES) Health Research Institute of the Balearic Islands (IdISBa)  Palma Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7433-188X","authenticated-orcid":false,"given":"Noelia","family":"Mancebo\u2010Salas","sequence":"additional","affiliation":[{"name":"Direcci\u00f3n General de Servicios Sociales Consejer\u00eda de Familia, Juventud y Pol\u00edtica Social, Comunidad de Madrid  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4253-6247","authenticated-orcid":false,"given":"Raquel","family":"Pelayo\u2010Alonso","sequence":"additional","affiliation":[{"name":"Hospital Universitario Marqu\u00e9s de Valdecilla\u2010IDIVAL  Santander Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1901-1036","authenticated-orcid":false,"given":"Zulema","family":"Gancedo\u2010Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Hospital Universitario Marqu\u00e9s de Valdecilla\u2010IDIVAL  Santander Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5711-8956","authenticated-orcid":false,"given":"Joan Ernest","family":"De Pedro\u2010G\u00f3mez","sequence":"additional","affiliation":[{"name":"Department of Nursing and Physiotherapy Universitat de les Illes Balears  Palma Spain"},{"name":"Care, Chronicity and Evidence in Health Research Group (CurES) Health Research Institute of the Balearic Islands (IdISBa)  Palma Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,12,13]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/BMJ.39335.541782.AD"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2018.01.049"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.7748\/nr2006.10.14.1.59.c6010"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/S40620\u2010021\u201001002\u20104"},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.V1051045"},{"key":"e_1_2_15_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneph.2011.28"},{"key":"e_1_2_15_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2013.12.008"},{"key":"e_1_2_15_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1744\u20109987.2009.00720.x"},{"key":"e_1_2_15_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.JIPH.2023.04.012"},{"key":"e_1_2_15_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/16094069211002749"},{"key":"e_1_2_15_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nefro.2016.11.016"},{"key":"e_1_2_15_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/13611260500069947"},{"key":"e_1_2_15_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525\u20101594.2005.29067.x"},{"issue":"2","key":"e_1_2_15_15_1","first-page":"99","article-title":"Seeking consensus through the use of the Delphi technique in health sciences research","volume":"42","author":"Falzanaro M.","year":"2013","journal-title":"Journal of Allied Health"},{"key":"e_1_2_15_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.techfore.2011.04.014"},{"issue":"2","key":"e_1_2_15_17_1","first-page":"26","article-title":"Predictors of hemodialysis central venous catheter exit\u2010site infections","volume":"18","author":"Harwood L.","year":"2008","journal-title":"CANNT Journal"},{"key":"e_1_2_15_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/NXN.0b013e31825e8923"},{"key":"e_1_2_15_19_1","doi-asserted-by":"publisher","DOI":"10.4321\/S2254\u201028842018000500001"},{"key":"e_1_2_15_20_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2005121372"},{"key":"e_1_2_15_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102648.2006.03716.x"},{"key":"e_1_2_15_22_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ackd.2018.10.005"},{"key":"e_1_2_15_23_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2008.08.024"},{"key":"e_1_2_15_24_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.01690213"},{"key":"e_1_2_15_25_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2019.12.001"},{"key":"e_1_2_15_26_1","doi-asserted-by":"publisher","DOI":"10.1086\/599376"},{"key":"e_1_2_15_27_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfu253"},{"key":"e_1_2_15_28_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir257"},{"key":"e_1_2_15_29_1","doi-asserted-by":"publisher","DOI":"10.1067\/mic.2002.129427"},{"key":"e_1_2_15_30_1","doi-asserted-by":"publisher","DOI":"10.3265\/Nefrologia.pre2011.Apr.10813"},{"key":"e_1_2_15_31_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2014.12.014"},{"key":"e_1_2_15_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/nur.20147"},{"key":"e_1_2_15_33_1","doi-asserted-by":"publisher","DOI":"10.5301\/jva.5000410"},{"key":"e_1_2_15_34_1","doi-asserted-by":"publisher","DOI":"10.1159\/000477271"},{"key":"e_1_2_15_35_1","doi-asserted-by":"publisher","DOI":"10.1053\/ajkd.2001.26873"},{"key":"e_1_2_15_36_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00256\u2010011\u20101145\u2010z"},{"key":"e_1_2_15_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/J.1525\u2010139X.2011.00869.X"},{"key":"e_1_2_15_38_1","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmp051"},{"key":"e_1_2_15_39_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2019.09.002"},{"key":"e_1_2_15_40_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2006.04.029"},{"key":"e_1_2_15_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.TECHFORE.2012.04.013"},{"key":"e_1_2_15_42_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfg581"}],"container-title":["Journal of Clinical Nursing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jocn.16941","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,23]],"date-time":"2024-01-23T04:40:57Z","timestamp":1705984857000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jocn.16941"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,13]]},"references-count":41,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,2]]}},"alternative-id":["10.1111\/jocn.16941"],"URL":"https:\/\/doi.org\/10.1111\/jocn.16941","archive":["Portico"],"relation":{},"ISSN":["0962-1067","1365-2702"],"issn-type":[{"type":"print","value":"0962-1067"},{"type":"electronic","value":"1365-2702"}],"subject":[],"published":{"date-parts":[[2023,12,13]]},"assertion":[{"value":"2023-05-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-11-13","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-12-13","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}