Cuffed Catheters Research Articles

Percutaneous transluminal angioplasty is safe and feasible for reinsertion of tunneled cuffed catheters in the right internal jugular vein

This study explores the feasibility, safety, and efficacy of percutaneous transluminal angioplasty (PTA) for reinserting tunneled cuffed catheters (TCC) with a Dacron sheath in the right internal jugular vein (RIJV) in hemodialysis patients with a history of prior RIJV catheterization and subsequent stenosis or occlusion of the RIJV, right innominate vein, and superior vena cava. Clinical data from 21 hemodialysis patients with dysfunctional vascular access who underwent PTA for reinsertion of TCC in the RIJVs from July 2020 to June 2023 at the First and Second Affiliated Hospitals of Bengbu Medical College were retrospectively analyzed. Clinical efficacy during hospitalization, postoperative TCC blood flow, and related complications during follow-up were observed. The procedure was successful in all 21 patients, with postoperative TCC blood flow meeting daily hemodialysis requirements. Only one case experienced acute bleeding with contrast agent extravasation at the intersection of the left and right innominate veins during sharp recanalization. No severe complications, such as arrhythmias, vascular rupture, pneumothorax, mediastinal hematoma, or pericardial tamponade, occurred during the procedures. Upon discharge, all patients exhibited satisfactory TCC blood flow (247.14 ± 11.46 ml/min). Postoperatively, TCC blood flow ranged between 200 and 260 ml/min, meeting the demands of regular hemodialysis. For patients with a history of repeated TCC or non-tunneled catheter (NTC) placement in the RIJV, reinserting TCC in the RIJVs through PTA is a safe and reliable technique. It effectively utilizes vascular resources and prevents vascular resource depletion associated with changing the venous catheter placement location.

Summary of Complications in Maintenance Hemodialysis Using Tunneled Cuffed Catheters (TCC) in Our Hospital

Summary of Complications in Maintenance Hemodialysis Using Tunneled Cuffed Catheters (TCC) in Our Hospital

Utility of covered stents as a bypass for the treatment of central venous occlusion: a case report

BackgroundCentral venous occlusion (CVO) is difficult to treat with percutaneous transluminal angioplasty because the guidewire cannot pass through the occluded segments. In this study, we devised a new method for establishing an extra-anatomic bypass between the right subclavian vein and the superior vena cava via a covered stent to treat whole-segment occlusion of the right brachiocephalic vein (BCV) with calcification.Case presentationWe present the case of a 58-year-old female patient who complained of right arm swelling present for 1.5 years. Twelve years prior, the patient began hemodialysis because chronic glomerulonephritis had progressed to end-stage renal disease. During the first 3 years, a right internal jugular vein (IJV)-tunneled cuffed catheter was used as the dialysis access, and the catheter was replaced once. A left arteriovenous fistula (AVF) was subsequently established. Owing to occlusion of the left AVF, a new fistula was established on the right upper extremity 1.5 years prior to this visit. Angiography of the right upper extremity revealed complete occlusion of the right BCV and IJV with calcification. Because of the failure to pass the guidewire across the lesion, we established an extra-anatomic bypass between the right subclavian vein and the superior vena cava with a covered stent. Angiography confirmed the patency of whole vascular access system. After 3 months of follow-up, the patient’s AVF function and the bypass patency were satisfactory.ConclusionsAs a new alternative for the treatment of long, angled CVO with or without calcification, a covered stent can be used to establish an extravascular bypass between central veins.

Spontaneous Intravascular Cephalad Migration of Tunneled Cuffed Catheter – An Unusual Late Complication and Role of Re-Imaging

Spontaneous Intravascular Cephalad Migration of Tunneled Cuffed Catheter – An Unusual Late Complication and Role of Re-Imaging

Dysbiosis and Staphylococcus species over representation in the exit site skin microbiota of hemodialysis patients carrying tunneled cuffed central venous catheter

Objectives Hemodialysis patients with end-stage renal disease (ESRD) are susceptible to infections and dysbiosis. Catheter-related infections are typically caused by opportunistic skin pathogens. This study aims to compare the skin microbiota changes around the exit site of tunneled cuffed catheters (peri-catheter group) and the contralateral site (control group). Methods ESRD patients on hemodialysis were recruited. The skin microbiota were collected with moist skin swabs and analyzed using high-throughput sequencing of the 16S rDNA V3–V4 region. After denoising, de-replication, and removal of chimeras, the reads were assigned to zero-radius operational taxonomic units (ZOTU). Results We found significantly reduced alpha diversity in the peri-catheter group compared to the control group, as indicated by the Shannon, Jost, and equitability indexes, but not by the Chao1 or richness indexes. Beta diversity analysis revealed significant deviation of the peri-catheter microbiota from its corresponding control group. There was an overrepresentation of Firmicutes and an underrepresentation of Actinobacteria, Proteobacteria, and Acidobacteria at the phylum level in the peri-catheter group. The most abundant ZOTU (Staphylococcus spp.) drastically increased, while Cutibacterium, a commensal bacterium, decreased in the peri-catheter group. Network analysis revealed that the skin microbiota demonstrated covariance with both local and biochemical factors. Conclusions In conclusion, there was significant skin microbiota dysbiosis at the exit sites compared to the control sites in ESRD dialysis patients. Managing skin dysbiosis represents a promising target in the prevention of catheter-related bacterial infections.

Amino polysaccharide quaternary ammonium salt grafted to PET‐Cuff by ultraviolet irradiation for improving the sustained antibacterial property of semi‐permanent central vein tunneled cuffed catheter

AbstractIn hemodialysis, tunneled cuffed catheter (TCC) is commonly used as a medical device for establishing vascular access. To address the current problem that the skin tunnel of TCC is susceptible to bacterial infection, this work proposes quaternized modification of the cuff of TCC to comprehensively enhance the long‐lasting antimicrobial performance of TCC. The morphology of the cuff basically resembles the polyethylene terephthalate (PET). Via ultraviolet (UV) irradiation, acrylic acid (AA) was grafted onto PET. Then, amino polysaccharide quaternary ammonium salt (As) replaced H+ of the carboxyl groups on the macromolecular chain of PET through solution post‐treatment method. Through the single factor experiment, the degree of grafting reached 159.8% under the optimum preparation conditions (AA concentration of 25 vol%, H+ concentration of 0.2 mol/L, photosensitizer capacity of 15 wt%, and photo‐irradiation time of 30 min). By the above method, we successfully synthesized a highly hydrophilic, well biocompatible, and highly efficient antimicrobial PET‐g‐PAA@As. Animal experiments and histological analyses showed that PET‐g‐PAA@As was superior to PET control and blank control groups in controlling infection and promoting wound healing. This catheter material with excellent biocompatibility, sustained antimicrobial activity, and wound healing ability will have great potential for use in hemodialysis.

Exploration of agr types, virulence-associated genes, and biofilm formation ability in Staphylococcus aureus isolates from hemodialysis patients with vascular access infections.

Staphylococcus aureus, is a pathogen commonly encountered in both community and hospital settings. Patients receiving hemodialysis treatment face an elevated risk of vascular access infections (VAIs) particularly Staphylococcus aureus, infection. This heightened risk is attributed to the characteristics of Staphylococcus aureus, , enabling it to adhere to suitable surfaces and form biofilms, thereby rendering it resistant to external interventions and complicating treatment efforts. Therefore this study utilized PCR and microtiter dish biofilm formation assay to determine the difference in the virulence genes and biofilm formation among in our study collected of 103 Staphylococcus aureus, isolates from hemodialysis patients utilizing arteriovenous grafts (AVGs), tunneled cuffed catheters (TCCs), and arteriovenous fistulas (AVFs) during November 2013 to December 2021. Our findings revealed that both MRSA and MSSA isolates exhibited strong biofilm production capabilities. Additionally, we confirmed the presence of agr types and virulence genes through PCR analysis. The majority of the collected isolates were identified as agr type I. However, agr type II isolates displayed a higher average number of virulence genes, with MRSA isolates exhibiting a variety of virulence genes. Notably, combinations of biofilm-associated genes, such as eno-clfA-clfB-fib-icaA-icaD and eno-clfA-clfB-fib-fnbB-icaA-icaD, were prevalent among Staphylococcus aureus, isolates obtained from vascular access infections. These insights contribute to a better understanding of the molecular characteristics associated with Staphylococcus aureus, infections in hemodialysis patients and provided more targeted and effective treatment approaches.

Establishing Long-Term Haemodialysis Vascular Access with Permcath in Children with Chronic Kidney Disease: A Single-Centre Retrospective Analysis

Background: In some regions, the types and sizes of tunneled central venous catheters (CVCs) are limited. Objective: The objective of this study was to review our experience with 10F Quinton Permcath catheters used for long-term vascular access in children of various ages and weights with chronic renal failure. Methods: Children with renal failure on maintenance hemodialysis who underwent placement of the 10F Quinton Permcath between June 2017 and June 2023 at the First Affiliated Hospital of Jinan University were included. We collected clinical data from children with the Permcath, including patients' gender, age, weight, and height. Additionally, data on catheter-related complications were gathered. Imaging data of the patients were obtained to compare the catheter route on imaging and the position of the catheter tip in each case. This enabled an analysis of the characteristics of vascular access establishment and its correlation with catheter-related complications in 11 children implanted with 10F Quinton Permcath. Results: Among the 11 children on maintenance hemodialysis with catheters, five were male, and six were female, with a median age of 9 years (range 8 - 10). The median body weight of the included patients was 23.00 kg (range: 19.95 - 24.30 kg). Eight cases involved placement in the right internal jugular vein (IJV), with the catheter tip located at the level of T8 in two cases, T5 in one case, and T7 in the remaining cases, with no early catheter dysfunction. Three patients underwent catheter placement in the left IJV, with the catheter tip located at the level of T5, T4, and the T7/T8 intervertebral space, respectively, and two cases of early catheter dysfunction occurred in two patients. There were no acute complications in the 11 cases following catheter insertion. Conclusions: Whenever feasible, the right IJV should be the preferred choice for establishing vascular access for the 10F Quinton Permcath in children with chronic kidney disease, regardless of age and weight. The tunnel route and catheter length within the tunnel can be adjusted to ensure the appropriate placement of double-lumen tunnelled cuffed catheters (TCC).

A 4-year tunneled hemodialysis catheter malpositioned into the azygos vein and how to remedy the hemodialysis circuit.

Mispositioning in the azygos vein is a rare but hazardous complication of central venous catheterization. A patient was admitted for a dysfunctional hemodialysis tunneled cuffed catheter (TCC) placed in the azygos vein for 4 years. Computed tomography angiography revealed multiple sites of occlusion, including the superior vena cava (SVC), right and left innominate veins (IVs), and right femoral vein. Percutaneous transluminal angioplasty and a TCC replacement based on a segment-by-segment recanalizing strategy were performed. First, an 8-Fr sheath was inserted through the left femoral vein approach to retrogradely traverse the occlusive SVC followed by a guidewire extending to the occlusive left IV. A left transjugular 15-cm snare was inserted to capture the transfemoral guidewire and achieve recanalization from the left IV to the SVC. Second, a transjugular guidewire was advanced through the dysfunctional TCC yet shunted into the left IV due to the inability to cross the SVC. A left transfemoral 15-cm snare was inserted to capture the guidewire and achieve complete recanalization from the right internal jugular vein to the SVC. Balloons were passed over the guidewires to dilate the obstructive lesions sequentially, and a new TCC was inserted successfully with the tip positioned in the right atrium.

A cross-sectional study on non-infectious dysfunction of hemodialysis cuffed catheter.

Dialysis cuffed catheter dysfunction results in inadequate dialysis, increased sepsis risk,and a shortenedcatheter life. It may be possible to prolong catheter function by identifying the causes of cuffed catheter dysfunction. This study was a cross-sectional descriptive study conducted in 2021-2022 on hemodialysis patients with jugular cuff catheters. The catheterizations were performed using the Seldinger technique and were confirmed by fluoroscopy. A 12-month follow-up was conducted with respect to the performance of the cuffed catheter. A total of 123 patients underwent hemodialysis over 2 years via a cuffed catheter. Catheters were most commonly inserted into the right internal jugular vein, with lengths of 19 cm (tip to cuff). The rate of dysfunction of cuffed catheters was 27.6%. Catheter-related thrombosis was the most common cause in 10 cases (29.4%), followed by catheter tip fibrin sheath in 8 cases (23.5%) and catheter tip malposition in 8 cases (23.5%). Furthermore, 18 patients (52.94%) of cuffed catheter dysfunction occurred within 3 months of catheter placement, based on our study. The dysfunction of cuffed catheters on the left side 23 (67.64%) is more prevalent than the right side 11 (32.35%) (P=0.043); the malposition of catheter tips is more prevalent on the left side (P=0.023). Most commonly, cuffed catheter dysfunction is caused by thrombosis, fibrin sheath formation, and catheter tip malposition. Cuffed catheter failure can be reduced by carefully monitoring the catheter's path and tip position, searching for fibrin sheaths when investigating cuffed catheter failure, and preventing thrombotic events.

In vitro study on the sealing effect of different shapes of cuff tracheal tubes under the lowest safe pressure

To compare the effectiveness of cylindrical-shaped and conical-shaped cuff catheters for airway closure using different pressure measurement methods at the lowest safe pressure and to guide the clinical application. Twenty-four patients with endotracheal intubation admitted to the intensive care unit (ICU) of Guangxi Medical University Cancer Hospital from December 2021 to January 2022 were enrolled. Leakage test in vitro was performed on the secretion on the patients' cuff. The needle and plunger from 20 mL syringe was separated, the syringe was sealed with adhesive, and the syringe nozzle was filled thoroughly to create a tracheal model. Consecutively, both cylindrical-shaped and conical-shaped cuff catheters were inserted into the simulated trachea, and the cuff pressure was calibrated to 20 cmH2O (1 cmH2O ≈ 0.098 kPa) before commencing the experiment. The viscosity of the secretion on the patients' cuff was classified (grade I was watery subglottic secretion, grade II was thick subglottic secretion, grade III was gel-like subglottic secretion), and the same viscosity secretion was injected into the catheter cuff. Utilizing a self-control approach, intermittent pressure measurement was initially conducted on both the cylindrical-shaped and conical-shaped cuff by improved pressure measurement method (intermittent pressure measurement group), followed by continuous pressure measurement experiment (continuous pressure measurement group). The leakage volume of the three viscosity subglottic secretions and the values of cuff pressure measurement of different shaped cuff catheters at 4, 6, 8 hours of inflation were recorded. A total of 180 retention samples were extracted from 24 patients with tracheal intubation during ventilation, with 90 samples in each of the two groups using different pressure measurement methods, and 30 samples of retention materials with different viscosities in each group. In the intermittent pressure measurement group, at 4 hours of inflation, all samples of secretion with grade I and grade II on cylindrical-shaped cuff leaked, while 3 samples of secretion with grade III also leaked. For conical-shaped cuff, 28 samples of secretion with grade I leaked, only 2 samples of secretion with grade II leaked, and there was no leak for secretion with grade III. At 6 hours of inflation, all samples of the three viscosity secretions on different shaped cuffs leaked. The leakage was gradually increased with the prolongation of inflation time. In the continuous pressure measurement group, at 4 hours of inflation, all samples of secretion with grade I on cylindrical-shaped cuff leaked, while 29 samples of secretion with grade II leaked, and there was no leak for secretion with grade III. For the conical-shaped cuff, 26 samples of secretion with grade I leaked, and there was no leak for secretion with grade II and grade III. At 6 hours of inflation, the conical-shaped cuff still had no leak for secretion with grade III. As the inflation time prolonged, the leakage of subglottic secretion on different shaped cuffs in both groups was gradually increased. At 8 hours of inflation, all samples experienced leakage, but the leakage of subglottic secretion on different shaped cuffs in the continuous pressure measurement group was significantly reduced as compared with the intermittent pressure measurement group [leakage for secretion with grade III (mL): 1.00 (0.00, 1.25) vs. 2.00 (1.00, 2.00) on the cylindrical-shaped cuff, 1.00 (0.00, 1.00) vs. 2.00 (2.00, 2.00) on the conical-shaped cuff, both P < 0.01]. The values of pressure measurement of cuffs with different shapes at different time points of inflation in the continuous pressure measurement group were within the set range (20-21 cmH2O). The cuff pressure at 4 hours of inflation in the intermittent pressure measurement group was significantly lower than the initial value (cmH2O: 18.3±0.6 vs. 20.0±0.0 in the cylindrical-shaped cuff, 18.4±0.6 vs. 20.0±0.0 in the conical-shaped cuff, both P < 0.01), and the cuff pressure in both shaped cuffs showed a significant decrease tendency as inflation time prolonged. However, there was no statistically significant difference in values of pressure measurement between the different shaped cuff catheters. Continuous pressure monitoring devices can maintain the effective sealing of conical-shaped cuff catheters at the lowest safe pressure. When using an improved pressure measurement method for intermittent pressure measurement and/or using a cylindrical cuff catheter, the target pressure should be set at 25-30 cmH2O, and the cuff pressure should be adjusted regularly.

CLINICO-MICROBIOLOGICAL SPECTRUM OF HEMODIALYSIS CATHETER-RELATED BLOOD STREAM INFECTIONS: A CONCISE REVIEW

The disease burden of chronic kidney disease is increasing worldwide, and with the growing population of patients requiring hemodialysis, more patients are placed on central venous catheters (CVCs). Vascular access infections significantly cause hospitalization and mortality among end-stage renal disease (ESRD) patients. As per the data from the United States, Gram-positive organisms account for almost 56% of the total cases of catheter-related bloodstream infection (CRBSI), in stark contrast to Indian studies showing a dominance of Gram-negative organisms. The prolonged use of non-tunnelled catheters, poor hygiene, lack of catheter care protocols, and the tropical climate pose unique challenges to control CRBSIs in resource-poor countries. The most effective strategy to prevent CRBSI is to minimize the duration of dialysis catheters. Other strategies include the introduction of strict catheter care protocols, using tunnelled cuffed catheters, anti-microbial lock solutions, and topical antimicrobials. Eradicating nasal carriage of Staphylococcus aureus also reduced the incidence of CRBSIs.Treatment of suspected CRBSI should be promptly initiated with empirical broad-spectrum antibiotics covering Gram-positive and Gram-negative organisms. Catheter removal is indicated only if the patient is clinically unstable, has metastatic infections, and those who do not respond to antibiotic therapy.

Assessment of dysfunctional tunneled hemodialysis catheters and outcome of endovascular salvage techniques: a simple solution to a complex problem.

The aim of this study was to evaluate the causes of the dysfunctional tunneled cuffed catheters (TCCs) using multi-spiral computed tomography venography (MSCTV), and to analyze the outcomes of endovascular salvage techniques. This retrospective review data from 27 patients who experienced TCC dysfunction between July 1, 2016 and January 31, 2021 was conducted. Patients' demographic data, clinical signs and symptoms, and imaging data were collected from interventional radiology database. MSCTV showed a range of abnormalities in the hemodialysis (HD) patients, including central venous occlusion (n = 4), fibrin sheath formation (n = 3), malposition of the catheter tips (n = 4), central venous perforation (n = 1), thrombus formation (n = 12), regular catheter exchange without determined lesions (n = 3). Interventional catheter salvage procedures were performed, such as catheter exchange, balloon disruption of a fibrin sheath, angioplasty for central vein stenosis, and stent deployment. The technical success rate for catheter insertions was 100%, and no procedure-related severe complications were observed. The 30-day catheter patency for all assessable catheters was 85.2%. The use of MSCTV showed abnormal findings in almost 88.9% of cases concerning dysfunctional TCC. In this study, the examined appropriate endovascular techniques were found to be safe and technically successful, with a low incidence of procedure-related complications.

Effect of a Multifaceted Intervention on the Incidence of Hemodialysis Catheter Dysfunction in a National Stepped-Wedge Cluster Randomized Trial

Effective strategies to prevent hemodialysis (HD) catheter dysfunction are lacking and there is wide variation in practice. In this post hoc analysis of the REDUcing the burden of dialysis Catheter ComplicaTIOns: a national (REDUCCTION) stepped-wedge cluster randomized trial, encompassing 37 Australian nephrology services, 6361 participants, and 9872 catheters, we investigated whether the trial intervention, which promoted a suite of evidence-based practices for HD catheter insertion and management, reduced the incidence of catheter dysfunction, which is defined by catheter removal due to inadequate dialysis blood flow. We also analyzed outcomes among tunneled cuffed catheters and sources of event variability. A total of 873 HD catheters were removed because of dysfunction over 1.12 million catheter days. The raw incidence was 0.91 events per 1000 catheter days during the baseline phase and 0.68 events per 1000 catheter days during the intervention phase. The service-wide incidence of catheter dysfunction was 33% lower during the intervention after adjustment for calendar time (incidence rate ratio= 0.67; 95% confidence interval [CI], 0.50-0.89; P= 0.006). Results were consistent among tunneled cuffed catheters (adjusted incidence rate ratio= 0.68; 95% CI, 0.49-0.94), which accounted for 75% of catheters (n= 7403), 97.4% of catheter exposure time and 88.2% of events (n= 770). Among tunneled catheters that survived for 6 months (21.5% of tunneled catheters), between 2% and 5% of the unexplained variation in the number of catheter dysfunction events was attributable to service-level differences, and 18% to 36% was attributable to patient-level differences. Multifaceted interventions that promote evidence-based catheter care may prevent dysfunction, and patient factors are an important source of variation in events.

Septic Pulmonary Embolism Associated with Hemodialysis Catheter-Related Bloodstream Infection

The most common predisposing factor of septic pulmonary embolisms is the presence of an infected right atrial thrombus. Rarely, it may occur as a complication of catheter-related bloodstream infection (CRBSI). The usual presentation is with fever, chest pain, and variable degree of dyspnea. The condition warrants prompt removal of the catheter in combination with systemic antibiotics. The most common organism reported to cause septic pulmonary embolism is Staphylococcus aureus followed by streptococcus, and rarely, Gram-negative bacilli. We present a case of septic pulmonary embolism in an adolescent on maintenance hemodialysis through a right internal jugular tunneled cuffed catheter in whom the catheter tip thrombus was associated with CRBSI due to Esherichia coli.

Persistent Increase in Serum Ferritin Levels despite Converting to Permanent Vascular Access in Pediatric Hemodialysis Patients: Pediatric Nephrology Research Consortium Study.

Our objective was to examine serum ferritin trends after conversion to permanent vascular access (PVA) among children who started hemodialysis (HD) using tunneled cuffed catheters (TCC). Retrospective chart reviews were completed on 98 subjects from 20 pediatric HD centers. Serum ferritin levels were collected at the creation of PVA and for two years thereafter. There were 11 (11%) arteriovenous grafts (AVG) and 87 (89%) arteriovenous fistulae (AVF). Their mean TCC use was 10.4 ± 17.3 months. Serum ferritin at PVA creation was elevated at 562.64 ± 492.34 ng/mL, increased to 753.84 ± 561.54 ng/mL (p = < 0.001) in the first year and remained at 759.60 ± 528.11 ng/mL in the second year (p = 0.004). The serum ferritin levels did not show a statistically significant linear association with respective serum hematocrit values. In a multiple linear regression model, there were three predictors of serum ferritin during the first year of follow-up: steroid-resistant nephrotic syndrome as primary etiology (p = 0.035), being from a center that enrolled >10 cases (p = 0.049) and baseline serum ferritin level (p = 0.017). Increasing serum ferritin after conversion to PVA is concerning. This increase is not associated with serum hematocrit trends. Future studies should investigate the correlation of serum transferrin saturation and ferritin levels in pediatric HD patients.

Insight into the Clonal Lineage and Antimicrobial Resistance of Staphylococcus aureus from Vascular Access Infections before and during the COVID-19 Pandemic.

Patients receiving hemodialysis are at risk of vascular access infections (VAIs) and are particularly vulnerable to the opportunistic pathogen Staphylococcus aureus. Hemodialysis patients were also at increased risk of infection during the COVID-19 pandemic. Therefore, this study determined the change in the molecular and antibiotic resistance profiles of S. aureus isolates from VAIs during the pandemic compared with before. A total of 102 S. aureus isolates were collected from VAIs between November 2013 and December 2021. Before the pandemic, 69 isolates were collected, 58%, 39.1%, and 2.9% from arteriovenous grafts (AVGs), tunneled cuffed catheters (TCCs), and arteriovenous fistulas (AVFs), respectively. The prevalence of AVG and TCC isolates changed to 39.4% and 60.6%, respectively, of the 33 isolates during the pandemic. Sequence type (ST)59 was the predominant clone in TCC methicillin-resistant S. aureus (MRSA) and AVG-MRSA before the pandemic, whereas the predominant clone was ST8 in AVG-MRSA during the pandemic. ST59 carrying the ermB gene was resistant to clindamycin and erythromycin. By contrast, ST8 carrying the msrA gene was exclusively resistant to erythromycin. The ST distribution for different VAIs changed from before to during the pandemic. The change in antibiotic resistance rate for different VAIs was closely related to the distribution of specific STs.

Association between vascular access type and depression in hemodialysis patients.

Hemodialysis is the most common treatment used for end-stage kidney disease (ESKD) patients and an arteriovenous fistula (AV) fistula is the preferred vascular access. The goal of our study was to investigate potential associations between vascular access type and depression. This was a cross-sectional survey of 180 patients receiving maintenance hemodialysis. The Beck Depression Inventory was used to assess degree of depression. Demographic factors, treatment details, and laboratory values were obtained from the hospital medical record. Fifty-two percent (n = 93) of the patients were being dialyzed using an AV fistula and 48% (n = 87) via a tunneled cuffed catheter. No significant differences were found between access type use in terms of gender (p = 0.266), presence of diabetes, hypertension, or peripheral artery disease (p = 0.409, p = 0.323, p = 0.317; respectively). The prevalence of Beck Depression Inventory scores greater than 14 (marking presence of depression) was significantly higher in the patients being dialyzed with a tunneled cuffed catheters (61%) compared to patients dialyzed with an AV fistula (36%) (p = 0.001). We found statistically higher depression scores among patients receiving hemodialysis with a tunneled cuffed catheter.

Effect of ticagrelor on the function of tunneled cuffed catheter in maintenance hemodialysis patients.

To observe the effect of ticagrelor on the function of a tunneled cuffed catheter (TCC) in maintenance hemodialysis (MHD) patients. Eighty MHD patients (control group: 39 cases, observation group: 41 cases) using TCC as vascular access were enrolled from January 2019 to October 2020 in this prospective study. Patients in the control group were routinely treated with aspirin for antiplatelet therapy, while patients in the observation group were treated with ticagrelor. The catheter life time, catheter dysfunction, coagulation function, and antiplatelet drug-related adverse events of the two groups were recorded. The median life time of TCC in the control group was significantly higher than that in the observation group. Moreover, the log rank test showed that the difference was statistically significant (p < 0.001). Ticagrelor may reduce the incidence of catheter dysfunction and prolong the life time of the catheter by preventing and reducing the thrombosis of TCC in MHD patients, without obvious side effects.

Hemodialysis Catheter-Related Blood Stream Infection: Rates, Risk Factors And Pathogens

Background: Central venous catheters (CVC) are an important means of delivering hemodialysis (HD) to patients who require immediate initiation of dialysis. Haemodialysis (HD) catheter-related bloodstream infections (CRBSIs) are a major complication of long-term catheter use in HD. Aims: This study was conducted to identify the rates, risk factors and spectrum of infecting organisms of Hemodialysis catheter-related blood stream infection (CRBSI). Methods: This prospective Observational study was carried out in the Department of Nephrology, Dhaka Medical College Hospital, Dhaka during January 2018 to July 2019. A total of 125 patients with Central Venous Catheter for Hemodialysis were included in this study. Results: Twenty four patients with a mean age of 42.9±17.5 years were confirmed to have CRBSI with a rate of 6.6 per 1000 catheter days in Temporary Uncuffed Catheter group and 1.4 per 1000 catheter days in Permanent Cuffed Catheter group. Independent risk factor associated with CRBSI was diabetes. 70.8% patients had gram-negative infections, 4(16.7%) patients had gram-positive infections and 3(12.5%) patients had polymicrobial infections. Pseudomonas species (37.5%) were the most common identified bacteria. Conclusion: The rate of CRBSI in Hemodialysis patients was significant and the only identified risk factor was diabetes mellitus. Infection by Gram-negative bacteria was noteworthy among the patients. J Dhaka Med Coll. 2021; 29(1): 3-8