Guidewire exchange vs new site placement for temporary dialysis catheter insertion in ICU patients: is there a greater risk of colonization or dysfunction?

Julien Bohé ,Stéphane Ruckly,Emmanuel Canet,Jean‐François Timsit ,François Vincent,Bertrand Souweine,Alain Lepape,Olivier Cointault,Élie Azoulay ,Alexandre Boyer,Alexandre Lautrette,Laurent Argaud,Michaël Darmon ,Lila Bouadma,Kada Klouche,Maïté Garrouste-Orgeas,Sophie Cayot,Carole Schwebel,Didier Gruson,Christophe Mariat,Elisabeth Coupez

doi:10.1186/s13054-016-1402-6

Abstract

BackgroundIntensive care unit (ICU) patients require dialysis catheters (DCs) for renal replacement therapy (RRT). They carry a high risk of developing end-stage renal disease, and therefore their vascular access must be preserved. Guidewire exchange (GWE) is often used to avoid venipuncture insertion (VPI) at a new site. However, the impact of GWE on infection and dysfunction of DCs in the ICU is unknown. Our aim was to compare the effect of GWE and VPI on DC colonization and dysfunction in ICU patients.MethodsUsing data from the ELVIS randomized controlled trial (RCT) (1496 ICU adults requiring DC for RRT or plasma exchange) we performed a matched-cohort analysis. Cases were DCs inserted by GWE (n = 178). They were matched with DCs inserted by VPI. Matching criteria were participating centre, simplified acute physiology score (SAPS) II +/-10, insertion site (jugular or femoral), side for jugular site, and length of ICU stay before DC placement. We used a marginal Cox model to estimate the effect of DC insertion (GWE vs. VPI) on DC colonization and dysfunction.ResultsDC colonization rate was not different between GWE-DCs and VPI-DCs (10 (5.6 %) for both groups) but DC dysfunction was more frequent with GWE-DCs (67 (37.6 %) vs. 28 (15.7 %); hazard ratio (HR), 3.67 (2.07–6.49); p < 0.01). Results were similar if analysis was restricted to DCs changed for dysfunction.ConclusionsGWE for DCs in ICU patients, compared with VPI did not contribute to DC colonization or infection but was associated with more than twofold increase in DC dysfunction.Trial registrationThis study is registered with ClinicalTrials.gov, number NCT00563342. Registered 2 April 2009.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1402-6) contains supplementary material, which is available to authorized users.

Highlights

Intensive care unit (ICU) patients require dialysis catheters (DCs) for renal replacement therapy (RRT)
Acute kidney injury (AKI) predisposes to end-stage renal disease (ESRD) [1, 2], and the preservation of the vascular network in the event of subsequent chronic dialysis is of foremost importance and may be challenging when short-term dialysis catheter (DC) placement is required for the provision of renal replacement therapy (RRT)
Results of the matched-cohort analysis Of the 2172 DCs recorded in the ELVIS database and used for the intention-to-treat analysis, 272 were inserted by Guidewire exchange (GWE) in 205 patients

Summary

Introduction

Intensive care unit (ICU) patients require dialysis catheters (DCs) for renal replacement therapy (RRT). They carry a high risk of developing end-stage renal disease, and their vascular access must be preserved. Guidewire exchange (GWE) is often used to avoid venipuncture insertion (VPI) at a new site. Acute kidney injury (AKI) predisposes to end-stage renal disease (ESRD) [1, 2], and the preservation of the vascular network in the event of subsequent chronic dialysis is of foremost importance and may be challenging when short-term dialysis catheter (DC) placement is required for the provision of renal replacement therapy (RRT). Guidewire exchange (GWE) is an alternative approach for changing DCs and has a lower risk of mechanical complications than VPI at new sites. GWE may predispose to infectious complications and is discouraged in central venous catheterization [14]

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