Abstract
Central tunneled catheter (CTC)-related infections are a leading cause of a catheter loss, thus being the source of significant morbidity and mortality. The study aims at evaluating the impact of the implementation of the innovative redness, edema, discharge and tenderness, symptoms (REDS) scale (devised by the authors) for the description of the tunnel condition on the frequency of infection in long-term catheter users. The same cohort of the 40 patients was observed for 4 years altogether: 2 years before and 2 years after REDS application. The results, as well as follow-up evaluation of participants, were compared. The 2-year cumulative incidence of the CTC exit site infection (ESI) dropped significantly (log-rank p < 0.001) from 0.89 episode/1,000 catheter days (53.5%, 95% CI [35.9%; 66.2%]) in the period before REDS was used—to 0.26 episode/1,000 catheter days (18.6%, 95% CI [6.1%; 29.4%]) in the time of REDS application. There were also significantly fewer episodes of ESI complicated with catheter-related blood stream infection (CRBSI) requiring the CTC removal (0.6 episode/1,000 catheter days; 18.6%, 95% CI [6.1%; 29.4%] vs. 0.3 episode/1,000 catheter days; 4.7%, 95% CI [0.0; 10.7%]; log-rank p = 0.04, in pre-REDS and REDS time, respectively). The REDS scale appears to be a simple, cost-effective tool reducing the frequency of the tunneled CTC exit site infection and associated bloodstream infections.
Highlights
Central tunneled catheter (CTC) is used in a large part of hemodialysis patients awaiting arteriovenous fistula maturation or as the only possible vascular access option when other ones have been exhausted and/or prevented by comorbidities
In 40 patients’ population, there were more women (22 vs. 18 men, respectively), medium aged of 65 years [87; 47], with diabetes mellitus (37.5%) as dominating cause of ESKD and dialyzed through a CTC mostly inserted into the right internal jugular vein (62.5%)
After the REDS scale introduction, exit site infection (ESI) occurrence decreased to the rate of 0.26 and 0.47 episode/1,000 cd in 2014 and 2015, respectively, compared with 0.89 episode/1,000 cd in both 2012 and 2013, in pre-REDS time (Table 2)
Summary
Central tunneled catheter (CTC) is used in a large part of hemodialysis patients awaiting arteriovenous fistula maturation or as the only possible vascular access option when other ones have been exhausted and/or prevented by comorbidities. Improper use of CTC carries a risk of life-threatening catheter-related bloodstream infections (CRBSI), often complicated with metastatic abscesses, endocarditis, not infrequently with fatal consequence [1,2,3,4,5]. Recent studies bring evidence that CTC exit site infection (ESI) may pre-dispose to CRBSI with occurrence in 4 to 20% cases. CTC Infection Prevention Innovative Tool of dialysis line-related sepsis [6, 7]. The purpose of this study was to determine the effect of implementation of the redness, edema, discharge and tenderness, symptoms (REDS) scale exit site evaluation (devised by the authors) on the rate of the catheter infection, as compared with the period when the exit site had been evaluated only at the nursing staff ’s discretion
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