Infection Rate of Tunneled Hemodialysis Catheters

Year 2021, Volume: 23 Issue: 1, 55 - 60, 30.04.2021

Ata Ecevıt Okay Güven Karaca Mehmet Kalender Osman Tansel Darçın

https://doi.org/10.18678/dtfd.869083

Cited By: 1

Abstract

Aim: Tunneled hemodialysis catheters are frequently used for hemodialysis patients and provide temporary venous access. However, it causes complications such as catheter-related infection, pneumothorax and hematoma. In this study, we aimed to evaluate the infections, complications and catheter patency rates that developed after the use of tunnel catheters connected to three different access routes.
Material and Methods: A total of 145 patients who underwent hemodialysis due to chronic renal failure and who were placed on permanent hemodialysis catheter were included. In this study, jugular vein route was used as the first choice for the dialysis access route, when other access routes were needed due to complications and infection, femoral vein route was the second choice, while subclavian vein route was the third choice.
Results: The femoral vein group had the highest infection rate and the lowest patency rate (both p<0.001). The infection rate at the end of one year was 65.3%, 95.6%, and 64.0% for the jugular vein, femoral vein and subclavian vein, respectively. At the end of one year, patency rates for the jugular vein, subclavian vein and femoral vein were 57.3%, 6.7%, and 32.0%, respectively.
Conclusion: Although the jugular vein is the first choice for venous entry in hemodialysis patients, femoral and subclavian veins are also used. In this study, the jugular vein was the best option in terms of patency rate and infection. The femoral vein, on the other hand, had the worst patency rate and was also the access route with the highest infection rate.

Keywords

Hemodialysis, Infestions, Catheters

Tünelli Hemodiyaliz Kateterlerinin Enfeksiyon Oranları

Abstract

Amaç: Tünelli hemodiyaliz kateterleri hemodiyaliz hastaları için sıklıkla kullanılır ve hastalara hemodializ için geçici venöz erişim sağlar. Ancak kateter ile ilişkili enfeksiyon, pnomotoraks ve hematom gibi komplikasyonlara neden olur. Bu çalışmada, üç farklı giriş yoluna bağlı tünelli kateterlerin enfeksiyon, komplikasyon ve açıklık oranlarının değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntemler: Çalışmaya kronik böbrek yetmezliği nedeniyle hemodiyaliz yapılan ve kalıcı hemodiyaliz kateteri takılan toplam 145 hasta dahil edildi. Bu çalışmada diyaliz giriş yolu olarak juguler ven yolu ilk tercih olarak kullanıldı, komplikasyonlar ve enfeksiyona bağlı olarak diğer giriş yollarına ihtiyaç duyulduğunda femoral ven yolu ikinci tercih olurken subklavian ven yol ise üçüncü tercih oldu.
Bulgular: Femoral ven grubu en yüksek enfeksiyon oranına ve en düşük açıklık oranına sahipti (her iki p<0.001). Birinci yılın sonunda enfeksiyon oranı juguler ven, femoral ven ve subklavyen vende sırasıyla %65,3; %95,6 ve %64,0 idi. Birinci yıl sonunda juguler ven, subklavyen ven ve femoral ven açıklık oranları ise sırasıyla %57,3; %6,7 ve %32,0 idi.
Sonuç: Hemodiyaliz hastalarında juguler ven venöz giriş için ilk seçenek olmasına rağmen femoral ve subklavyen venler de kullanılmaktadır. Bu çalışmada, juguler ven açıklık oranı ve enfeksiyon açısından en iyi seçenek idi. Diğer taraftan, femoral ven ise en kötü açıklık oranına sahipti ve aynı zamanda enfeksiyon oranı en yüksek olan giriş yolu idi.

Keywords

Hemodializ, Enfeksiyonlar, Kateter

References

• Kramer A, Stel V, Zoccali C, Heaf J, Ansell D, Grönhagen-Riska C, et al. An update on renal replacement therapy in Europe: ERA-EDTA Registry data from 1997 to 2006. Neprol Dial Transplant. 2009;24(12):3557-66.
• Vascular Access Work Group. Clinical practice guidelines for vascular access. Guideline 7. Prevention and treatment of catheter and port complications. Am J Kidney Dis. 2006;48(Suppl 1):S248-73.
• Lok CE, Huber TS, Lee T, Shenoy S, Yevzlin AS, Abreo K, et al. KDOQI clinical practice guideline for vascular access: 2019 update. Am J Kidney Dis. 2020;75(4 Suppl 2):S1-S164.
• Funaki B. Central venous access: A primer for the diagnostic radiologist. Am J Roentgenol. 2002;179(2):309-18.
• Swartz RD, Messana JM, Boyer CJ, Lunde NM, Weitzel WF, Hartman TL. Successful use of cuffed central venous hemodialysis catheters inserted percutaneously. J Am Soc Nephrol. 1994;4(9):1719-25.
• Marr KA, Sexton DJ, Conlon PJ, Corey GR, Schwab SJ, Kirkland KB. Catheter-related bacteremia and outcome of attempted catheter salvage in patients undergoing hemodialysis. Ann Intern Med. 1997;127(4):275-80.
• Adar R, Mozes M. Fatal complications of central venous catheters. Br Med J. 1971;3(5777):746.
• Allon M, Brouwer-Maier DJ, Abreo K, Baskin KM, Bregel K, Chand DH, et al. Recommended clinical trial endpoints for dialysis catheters. Clin J Am Soc Nephrol. 2018;13(3):495-500.
• Tsotsolis N, Tsirgogianni K, Kioumis I, Pitsiou G, Baka S, Papaiwannou A, et al. Pneumothorax as a complication of central venous catheter insertion. Ann Transl Med. 2015;3(3):40.
• Peng HC, Lin SM, Wu YS, Chang WK, Sung CS, Chan KH. Transesophageal echocardiography for diagnosis of acute hemothorax during the insertion of hemodialysis catheter. Acta Anestesiol Taiwan. 2007;45(3):181-4.
• Kusminsky RE. Complications of central venous catheterization. J Am Coll Surg. 2007;204(4):681-96.
• Eisen LA, Narasimhan M, Berger JS, Mayo PH, Rosen MJ, Schneider RF. Mechanical complications of central venous catheters. J Intensive Care Med. 2006;21(1):40-6.
• Laronga C, Meric F, Truong MT, Mayfield C, Mansfield P. A treatment algorithm for pneumothoraces complicating central venous catheter insertion. Am J Surg. 2000;180(6):523-7.
• Vats HS. Complications of catheters: tunneled and nontunneled. Adv Chronic Kidney Dis. 2012;19(3):188-94.
• Bhutta ST, Culp WC. Evaluation and management of central venous access complications. Tech Vasc Interv Radiol. 2011;14(4):217-24.
• Valji K. Vascular and interventional radiology. 2nd ed. Edinburgh: Elsevier Saunders, 2006.
• Schummer W, Schummer C, Rose N, Niesen WD, Sakka SG. Mechanical complications and malpositions of central venous cannulations by experienced operators. A prospective study of 1794 catheterizations in critically ill patients. Intensive Care Med. 2007;33(6):1055-9.
• Roldan CJ, Paniagua L. Central venous catheter intravascular malpositioning: Causes, prevention, diagnosis, and correction. West J Emerg Med. 2015;16(5):658-64.
• Liberek T, Świąder W, Koprowski A, Baścik B, Dębska-Ślizień A. Tunnelled haemodialysis catheter insertion into the persistent left superior vena cava. J Vasc Access. 2020;[Epub ahead of print]. doi: 10.1177/1129729820933529.
• Webb JG, Simmonds SD, Chan-Yan C. Central venous catheter malposition presenting as chest pain. Chest. 1986;89(2):309-12.
• Gibson F, Bodenham A. Misplaced central venous catheters: applied anatomy and practical management. Br J Anaesth. 2013;110(3):333-46.
• Nayeemuddin M, Pherwani AD, Asquith JR. Imaging and management of complications of central venous catheters. Clin Radiol. 2013;68(5):529-44.
• Allon M. Current management of vascular access. Clin J Am Soc Nephrol. 2007;2(4):786-800.
• Yevzlin AS, Sanchez RJ, Hiatt JG, Washington MH, Wakeen M, Hofmann RM, et al. Concentrated heparin lock is associated with major bleeding complications after tunneled hemodialysis catheter placement. Semin Dial. 2007;20(4):351-4.
• Garnacho-Montero J, Aldabó-Pallás T, Palomar-Martínez M, Vallés J, Almirante B, Garcés R, et al. Risk factors and prognosis of catheter-related bloodstream infection in critically ill patients: a multicenter study. Intensive Care Med. 2008;34(12):2185-93.
• Allon M. Dialysis catheter-related bacteremia: treatment and prophylaxis. Am J Kidney Dis. 2004;44(5):779-91.
• Lok CE, Stanley KE, Hux JE, Richardson R, Tobe SW, Conly J. Hemodialysis infection prevention with polysporin ointment. J Am Soc Nephrol. 2003;14(1):169-79.
• Ashby DR, Power A, Singh S, Choi P, Taube DH, Duncan ND, et al. Bacteremia associated with tunneled hemodialysis catheters: outcome after attempted salvage. Clin J Am Soc Nephrol. 2009;4(10):1601-5.
• Saad TF. Bacteremia associated with tunelled, cuffed hemodialysis catheters. Am J Kidney Dis. 1999;34(6):1114-24.
• Robinson D, Suhocki P, Schwab SJ. Treatment of infected tunelled venous access hemodialysis catheters with guidewire exchange. Kidney Int. 1998;53(6):1792-4.