Outcome and complications of temporary haemodialysis catheters.

Abstract

The use of temporary haemodialysis catheters is often complicated by mechanical or infectious complications. Risk factors for these complications and optimal management to reduce their incidence are largely unknown. We conducted a prospective study of 105 haemodialysis catheters (79 subclavian, 26 jugular) inserted in 52 patients in order to identify patient outcomes and to analyse the effect of patient and catheter factors on the incidence of infectious complications by multivariate analysis. Fifty-nine per cent of catheters were removed for a suspected complication. Catheter-related bacteraemia (CRB) was diagnosed in 17 catheters (16%), giving a bacteraemia rate of 6.5 episodes per 1000 catheter days. Subgroup analysis revealed a higher risk of CRB with the use of the internal jugular compared with the subclavian site (hazard ratio 3.97, P=0.02). Age, diabetes or catheter exchange over a guidewire did not alter the risk of CRB. The cumulative risk of developing CRB increased in a linear fashion as the period of catheterization increased. Exit-site infection was the cause for removal in eight catheters (8%). Although the number of exit-site infections was small, the risk of exit-site infection was increased in diabetic patients (hazard ratio 10, P=0.03) and the jugular position (hazard ratio 6.5, P=0.01) but not by age or catheter exchange over a guidewire. Staphylococcus aureus and coagulase-negative staphylococcus accounted for all proven episodes of CRB. Exit-site infection was associated with a mixture of Gram-positive and Gram-negative organisms. Temporary haemodialysis catheters have a high failure rate associated with a significant rate of complications. Use of the internal jugular site is associated with a significantly higher risk of infectious complications and methods to reduce this risk should be considered if this site is used.