Catheters In Hemodialysis Patients Research Articles

#2430 Comparison of the efficacy of gentamicin-citrate and gentamicin-citrate/Taurolock-urokinase locks for non-tunneled catheters in hemodialysis patients

Abstract Background and Aims Catheter-related complications, such as dysfunction, thrombosis and infection, are associated with significant morbidity and mortality in patients on hemodialysis (HD) receiving dialysis through temporary non-tunneled double-lumen central venous catheters (CVC). Catheter lock solutions containing antibiotics and antitrombolytics are commonly used to prevent such complications. The aim of the present study was to compare impact of a different prophylactic catheter lock solutions on the incidence of catheter-related complications (catheter-related bloodstream infection (CRBSI) and catheter thrombosis) and mortality compared with heparin catheter locks. Method We performed a single-centre prospective, randomized, single-blinded controlled trial of 96 adult patients undergoing HD in our institution from Jun 2018 to Jun 2023. Patients were randomized 1:1:1 to receive either a lock solution combining gentamicin-citrate twice a week with taurolidine-citrate (Taurolock)/urokinase at the end of the third hemodialysis session before the end of the week (TAURO group) or gentamicin-citrate at the end of all hemodialysis sessions (GENTAM group) or unfractionated heparin 5000 U/mL thrice weekly as control (HEPARIN group). Catheter lock solutions were administered for 3 months after insertion of CVC and patients were followed for at least 6 months after insertion of CVC. Demographic, clinical and laboratory parameters, as well as used medications, were analyzed. Episodes of acute catheter thrombosis and incidence of CRBSI were recorded, along with dialysis adequacy (Kt/V) and adverse events. Results The study population (96 patients, 32 in each group) had a median age of 60 years (range 19–85 years), 56.3% man. In the majority of patients (88.5%) the indication for placement of the CVC was the initiation of dialysis, while in the remaining patients indication was thrombosis of the existing vascular access. The most important baseline clinical and laboratory values are presented in Table 1. The catheter median length of stay was of 125.94 ± 87.48 (from 50 to 535) days in TAURO group, 113.44 ± 35.68 (from 54 to 233) days in GENTAM group and 108.59 ± 37.84 (from 42 to 212) days in HEPARIN group (p = 0.831). There was no difference between groups with regard to catheter thrombosis (3.3 events/1000 catheter-days in all groups). The CRBSI rate of 3.2 episodes/1000 catheter-days in TAURO group was slightly lower than the rate of 5.3 episodes/1000 catheter-days in GENTAM group (p = 0.479) and 4.3 episodes/1000 catheter-days in control HEPARIN group (p = 0.705). The CRBSI-free survival time in TAURO group was 197 ± 220 (from 28 to 447) days, longer than in the GENTAM group (38 ± 33 days, from 8 to 86) and HEPARIN group (37 ± 35 days, from 4 to 86), p = 0.21. Impact of catheter lock solution on dialysis adequacy as measured by Kt/V in time is presented in Fig. 1. No significant differences were found between study groups in survival after 6 months (p = 0.810) and at the end study period (p = 0.096)-presented in Fig. 1. Conclusion We observed no difference in the incidence of catheter thrombosis and mortality rate in groups with prophylactic catheter lock solutions and control group. The use of Gentamicin-citrate/Taurolock-urokinase as a dialysis catheter lock solution, as compared with gentamicin-citrate or heparin administered three times a week, led to a nonsignificant reduction of CRBSI incidence and longer CRBSI-free survival time in patients on HD receiving dialysis through temporary non-tunneled double-lumen CVC.

Reinsertion of tunneled-cuffed catheter in hemodialysis patients with catheter loss and limited access options.

Maintenance hemodialysis patients who rely on tunneled-cuffed catheters (TCCs) often face difficulty in reinserting a new catheter when the original catheter has been extruded or removed. Potential pathological changes of vessel caused by long-term indwelling of a catheter may contribute to this predicament. The aim of this study was to report and evaluate a re-catheterization technique through the same exit site and tunnel for hemodialysis patients with TCC loss. A retrospective review of 19 patients with TCC loss was conducted from January 2020 to August 2022. These patients underwent reinsertion through the same exit site and subcutaneous existing tunnel. Procedure-related complications and clinical follow-up data were collected. All 19 patients with catheter loss underwent this procedure and the median duration of catheter loss was 14 days (5-57 days). Five of them had central venous occlusion, and four of them experienced catheter loss due to removal for catheter-related bloodstream infections (CRBI). In the end, 18 case received successful catheterization using this technique. The most common complication was minimal bleeding after the operation. There were no procedure-related deaths or serious complications. The average blood flow was 265.79 ± 25.89 ml/min at the end of the follow-up period. This maneuver is a safe and convenient technique that can be used to reinsert a TCC for patients with long-time catheter loss. It helps to preserve the limited central venous resources for patients who have difficulty establishing other stable vascular access.

Cuffed-tunneled catheters in hemodialysis patients: problems and solution methods: A single-center retrospective cohort study

Background/Aim: Cuffed-tunneled catheter patients encounter various problems during their catheterization period. Early detection and resolution of these problems prolong the life of the catheter. The purpose of the present study was to investigate the problems and solution methods of cuffed-tunneled catheters in hemodialysis patients during their use in light of our experience and literature. Methods: The study was designed as a retrospective cohort study. Twenty-four months of patient data who had a diagnosis of renal failure and who received cuffed-tunneled hemodialysis catheters between January 2013 and June 21 in the Department of Cardiovascular Surgery of Adiyaman University Faculty of Medicine were analyzed electronically based on the hospital data recording system. The demographic characteristics, localization of the inserted catheter, and duration of catheter use were determined. Primary and secondary patency ratios were calculated and recorded along with the complications in the patients and our treatment approaches to these complications. Finally, the collected data were discussed with reference to the literature data. Results: The data from 322 cuffed-tunneled catheters were collected in a total of 228 patients during the observation period. It was found that no revision procedure was applied to 73 patients (catheter) during the 24-month period, and a total of 204 revision procedures were applied to 155 patients. The revision procedure consisted of 110 thrombolytic treatments, 64 vein exchanges, 18 tunnel changes, and 12 catheter changes. Primary and secondary patency ratios at 6, 12, 18, and 24 months were calculated as 90.79%, 63.60%, 40.11%, and 32.02% and 96.05%, 89.91%, 72.37%, and 58.33%, respectively. The most common factors that affected primary and secondary patency ratios were determined to be gender (P<0.001 and P=0.056, respectively), body mass index (P<0.001 and P<0.001, respectively) and diabetes mellitus (P=0.018 and P=0.690, respectively). Conclusion: Thrombolytic treatment is an effective and safe method in catheter thrombosis, which is one of the most important factors rendering the cuffed-tunneled hemodialysis catheters dysfunctional. Also, in tunnel infections, tunnel replacement is a salvage procedure in patients with vascular access problems.

Durability of the two-lumen catheter in hemodialysis patients; Ethanol 70%-heparin versus cefazolin-heparin: a randomized, double-blind clinical trial study

Introduction: Maintenance of hemodialysis catheters is essential for the patients and medical staff due to their repeated use for hemodialysis and other therapeutic interventions in the hospital. Objectives: This study aimed to comprise the effect of ethanol 70%-heparin versus cefazolin-heparin on the catheter durability time of hemodialysis patients. Patients and Methods: The study population consisted of 73 hemodialysis patients referred to Shahid Mohammadi hospital in Bandar Abbas. Patients were divided into two groups cefazolin (cefazolin 5 mg/dL, and heparin 2500 IU/mL) and ethanol (ethanol 70%, and heparin 2500 IU/mL). In both groups, after each hemodialysis session, 2.9 to 3.3 mL of the locking solution was locked in the catheter lumen and remained until the next session. This intervention was conducted for all patients continuously for five months. The time of catheter durability was calculated from the time of catheter placement in the central vein until the time that it has been taken out according to the doctor’s diagnosis. Data were collected and analyzed by SPSS version 26. Results: Results showed that demographic characteristics, including age, weight, gender, marital status, catheter type, underlying diseases, and dialysis adequacy between the two groups were similar (P>0.05). In the ethanol group, the mean time of the catheter durability was 27.5 days, and in the cefazolin group was 26.98 days. Although the time of the catheter durability was slightly higher in the ethanol group, this difference was not significant (P=0.194). Conclusion: Cefazolin and ethanol 70% did not show a significant difference in the catheter durability time of hemodialysis patients. Trial Registration: The trial protocol was approved by the Iranian Registry of Clinical Trials (IRCT20210811052145N1; https://en.irct.ir/trial/58037, ethical code; IR.HUNS.REC.1398.052).

Long Term patency of Tunneled catheters in End Stage Renal Disease patients for vascular access- A single center study

Aim: To look for the success and survival rate of tunneled catheters in hemodialysis patients. Design: Prospective study Duration & place of study: Department of Nephrology, Shaikh Zayed Hospital, Lahore from January 2017 to January 2018. Methodology: This study comprised of 71 consecutive subjects in whom tunneled catheters were inserted. The ESRD patients requiring permanent access for hemodialysis because of AVF failure, cardiomyopathy, waiting time for AVF maturation or renal transplantation were selected, those with previous permanent catheter insertions were excluded. The catheter was inserted in right internal jugular vein with doppler ultrasound. Result: The study included 71 patients; average age was 41±13 years, of them 43 were males. The success rate to insert catheter in an ideal location was observed in 73.2% and in non-ideal place in 26.8%patients. It was removed in67.6% and remained in situ till end of study in 32.4% patients. Functional AV fistula, renal transplantation and resolving AKI were elective reasons to remove catheters in 40%, 29% and 2% patients. The mean time of duration where tunneled catheter continued to serve as a vascular access and removed electively without catheter related problems was significantly different with Conclusion: The success rate of permanent catheter insertion was 99.2 % in our study. The catheter insertion under doppler ultrasound vision by a nephrologist offers a long lasting, safe and reliable alternative to restore a vascular access. Keywords: End Stage Renal Disease, Tunneled Catheter, Hemodialysis

Determinants of Tunneled Hemodialysis Catheter Implantation Time by Ultrasound Guidance: A Single-Center Cross-Sectional Study.

Background: We have previously reported that the ultrasound (US)-guided tip positioning is an accurate and safe procedure for placement of retrograde- and antegrade-tunneled hemodialysis catheters (HDCs). However, determinants of tunneled hemodialysis catheter implantation time by using US guidance have not been described yet. Therefore, we here report a comparative analysis to identify determinants of implantation time for retrograde- and antegrade-tunneled HDCs placement by US guidance. Methods: We performed a cross-sectional study to compare implantation time for US-guided tip positioning of retrograde- and antegrade-tunneled HDCs. We included a total number of 47 tunneled HDC insertions, including 23 retrograde tunneled and 24 antegrade-tunneled HDCs in patients requiring placement of an HDC for the temporary or permanent treatment of end-stage kidney disease (ESKD) in a single-center, cross-sectional pilot study. Results: We show that clinical and laboratory parameters did not differ between retrograde- and antegrade-tunneled HDC implantations. There was a tendency for shorter implantation time in antegrade-tunneled HDCs, although not statistically significant. Finally, we identified an independent inverse association between body weight (BW) and platelet counts with HDC implantation time specifically in antegrade-tunneled HDCs. Conclusion: In this study, we identified determinants for tunneled HDC implantation time that might be relevant for patients and interventionists.

Survival Rate of Tunneled Hemodialysis Catheters in Patients on Hemodialysis due to Chronic Kidney Disease (CKD)

Objectives: To determine the survival rate and reasons of failure of tunneled hemodialysis catheters in patients on hemodialysis due to chronic kidney disease (CKD). Study Design: Prospective case series. Place and Duration of Study: Department of Nephrology, Sheikh Zayed hospital Rahim Yar Khan from 1-June-2020 to 30-June-2021. Methodology: A total number of 195 patients of CKD in whom tunneled hemodialysis catheters (HDCs) were inserted for hemodialysis were included. Data regarding baseline study variables e.g. age, and gender, site of insertion and reason for removal was also collected. All patients were followed for 06 months to determine the survival rate of tunneled hemodialysis catheters. Results: Mean age in this study was 46.79±13.54 years. There was 130 (66.7%) male population. HDC was inserted in Jugular vein in 184 (94.4%) patients and in subclavian vein in only 11 (5.6%) patients. HDCs were survived in 156 (80%) patients at 3 months and in 134 (68.7%) patients at 6 months follow-up. The reasons for removal of HDCs were sepsis in 16 (8.2%) patients, catheter clotting in 14 (7.7%) patients and mechanical damage in 8 (4.1%) patients. On univariate analysis, we did not find any statistical association of advanced age, female gender, diabetes and hypertension with failure of HDCs. Conclusion: The 06 month’s survival rate of HDCs was 68.7%. Sepsis was the predominant cause of failure of these catheters. Keywords: Chronic kidney disease, Tunneled hemodialysis catheters, Survival rate.

The rapid atrial swirl sign for ultrasound-guided tip positioning of antegrade-tunneled hemodialysis catheters: A cross-sectional pilot study.

We have previously reported that the rapid atrial swirl sign (RASS) is an accurate and safe procedure for ultrasound (US)-guided tip positioning of retrograde-tunneled hemodialysis catheters (HDCs). However, application of RASS for placement of antegrade HDCs has not been investigated yet. Therefore, we here report our first experience of applying RASS for US-guided tip positioning of antegrade-tunneled HDCs. We performed a cross-sectional study to assess the feasibility of applying the RASS for US-guided tip positioning of antegrade-tunneled HDCs. We included a total number of 15 antegrade-tunneled HDC insertions in 13 patients requiring placement of a HDC for the temporary or permanent treatment of ESKD in a single-center, cross-sectional pilot study. The overall success rate of applying the RASS for US-guided tip positioning of antegrade-tunneled HDCs was 15/15 (100%) confirmed by portable anterior-posterior chest radiography, with no major adverse events after HDC insertions. In addition, this insertion technique demonstrated optimal HDC flow without any observed malfunction. This study investigated the efficacy of the RASS for US-guided tip positioning of antegrade-tunneled HDCs in patients with ESKD. Application of the RASS for US-guided tip positioning is an accurate and safe procedure for proper placement of antegrade-tunneled HDCs.

344 Risk of CLABSI With Dual-Lumen Versus Triple-Lumen Catheters in Hemodialysis Patients: A Quality Improvement Initiative

344 Risk of CLABSI With Dual-Lumen Versus Triple-Lumen Catheters in Hemodialysis Patients: A Quality Improvement Initiative

Hemodialysis Catheter-Related Infections: Incidence in Temporary Catheters locked with Vancomycin and Heparin vs. Heparin-only

Background: The increasing incidence of end stage renal disease (ESRD) patients initiating hemodialysis (HD) through a temporary HD catheter has caused the rise in catheter related infections and associated morbidity and mortality. An antibiotic lock solution (ALS) for the prevention of catheter-related bacteraemia is a promising strategy. The present randomized control study has evaluated the efficacy and safety of vancomycin as an ALS in 54 patients who required temporary double lumen catheters for HD.
 Methods: The patients were randomized to receive either (A) an ALS (vancomycin 5 mg/ml + heparin 5000 IU/ml) – group A; or (B) unfractionated heparin (5000 IU/ml) alone as a catheter lock control – group B. The study duration was of three months and was conducted at the Department of Nephrology, PIMS, Islamabad.
 Results: The primary endpoint of the study was catheter related blood stream infection (CRBSI). The vancomycin group (A) had one episode of infection (CRBSI rate = 1.23/1000 days) compared with six episodes in the heparin-locked control group (B) (CRBSI rate = 8.55/1000 days). Mean catheter survival was significantly (p<0.05) more in group A (30.48 ± 5.7days) compared to group B (26 ± 6.5 days). No thrombotic episodes or side effects were recorded.
 Conclusion: Vancomycin appeared to be a safe and effective ALS, preventing CRBSI and increasing survival of catheter in HD patients.

The best solution down the line: an observational study on taurolidine- versus citrate-based lock solutions for central venous catheters in hemodialysis patients

IntroductionTo prevent infection and thrombosis of central venous catheters (CVCs) in hemodialysis patients, different CVC lock solutions are available. Taurolidine-based solutions and citrate in different concentrations are frequently used, but no definite conclusions with regard to superiority have been drawn.MethodsIn this retrospective, observational, multicenter study, we aimed to assess the risk for removal of CVC due to infection or catheter malfunction in hemodialysis patients with CVC access for different lock solutions: taurolidine, high-concentrated citrate (46.7%) and low-concentrated citrate (4 or 30%). A multivariable Cox-regression model was used to calculate hazard ratio’s (HR).ResultsWe identified 1514 patients (median age 65 years, 59% male). In 96 (6%) taurolidine-based lock solutions were used. In 1418 (94%) citrate-based lock solutions were used (high-concentrated 73%, low-concentrated 20%). Taurolidine-based lock solutions were associated with a significantly lower hazard for removal of CVC due to infection or malfunction combined (HR 0.34, 95% CI 0.19–0.64), and for removal of CVC due to infection or malfunction separately (HR 0.36, 95% CI 0.15–0.88 and HR0.33, 95% CI 0.14–0.79). High-concentrated citrate lock solutions were not associated with a decreased hazard for our outcomes, compared to low-concentrated citrate lock solutions.ConclusionRemoval of CVC due to infection or catheter malfunction occurred less often with taurolidine-based lock solutions. We present the largest cohort comparing taurolidine- and citrate-based lock solutions yet. However, due to the retrospective observational nature of this study, conclusions with regard to superiority should be drawn with caution.

BACTERIAL SPECTRUM AND ANTIMICROBIAL PATTERN OF BLOOD STREAM INFECTIONS ASSOCIATED WITH NON-TUNNELED DOUBLE LUMEN CATHETER IN HEMODIALYSIS PATIENTS

Objective: To assess Bacterial spectrum and antimicrobial pattern of Blood Stream Infections associated with non-tunneled double lumen catheter in hemodialysis patients.
 Study Design: Prospective observational study.
 Place and Duration of Study: Department of Nephrology, Pakistan Emirates Military Hospital Rawalpindi Pakistan; Armed Forces Institute of Pathology Rawalpindi, Pakistan, from May 2019 to Apr 2020.
 Methodology: A total of 753 patients underwent placement of non-tunneled double lumen catheter (457 femoral, 296 Internal Jugular). Patients with clinically suspected bloodstream infections had their catheters removed with tips being sent for culture along with 2 sets of peripheral blood cultures. Patients were labelled as having bloodstream infection if growth of organism was detected in catheter tip and at least one peripheral blood culture. Susceptibility testing was done for available antimicrobials.
 Results: One hundred and thirty six (18.06%) incidences or 5.48 bloodstream infections per 1000 catheter days, with confirmed growth on blood cultures were identified. Gram positive infections were seen in 76 (55.88%) individuals with most common organism being coagulase-negative Staphylococcus (28.68%), followed by Staphylococcus aureus (21.32%). These organisms had low resistance rates to Vancomycin (0%), Tigecycline (0%), Doxycycline (6.6%) and Linezolid (9.5%). Gram negative infections were seen in 60 (44.11%) patients with Klebsiella pneumoniae (13.24%) being the most commonly identified pathogen followed by Acinetobacter baumannii (12.50%) and had relatively higher degree of antimicrobial resistance.
 Conclusion: Gram positive organisms were the most common cause of bloodstream infection in this study and were found susceptible to vancomycin and doxycycline whereas gram-negative organisms had high rates of antimicrobial......

Role of Fine Management in Maintenance of Deep Venous Indwelling Catheter in Hemodialysis Patients

Objective: This paper mainly explores the effect of fine management application in maintenance of deep venous indwelling catheter in hemodialysis patients. Methods: 150 hemodialysis patients with deep venous catheter indwelling in our hospital from December 2019 to September 2020 were divided into routine group and study group. The routine group was given routine nursing, and the study group was given fine management nursing. The nursing effect of the two groups was analyzed. Results: After nursing intervention, the incidence of complications in the study group was 14.66%, which was lower than that in the conventional group (53.33%), and the nursing compliance in the study group (98.66%) was higher than that in the conventional group (89.33%), all P < 0.05. Conclusion: Fine management plays a significant role in the maintenance of deep venous indwelling catheter in hemodialysis patients, which can reduce the occurrence of complications.

Placing a Hemodialysis Catheter in Patients With Multiple Access Failure and Exhausted Usual Approachable Veins: Egyptian Single Center Experience

Highlights Abstract Background: End-stage renal disease (ESRD) is a growing global health hazard. Most patients are maintained on dialysis rather than transplantation. Adequate vascular access for hemodialysis is crucial to achieve an optimal dialysis dose and to reduce morbidity and mortality. Patients with multiple access failure are in desperate need for lifesaving access, especially in the absence of alternatives (transplantation or peritoneal dialysis). Objective: Patients with multiple vascular access failure and exhausted approachable veins are being referred to an interventional nephrology or radiology centers. The aim of this work is to evaluate a single center’s experience of sophisticated venous approaches to provide access for hemodialysis. Methods: This study was performed at the Interventional Nephrology Center at Kasr Al-Ainy University Hospitals. Epidemiological data of patients, e.g., age, gender, as well as the number of previously cannulated central veins, were documented. Results: Data of 188 patients with multiple dialysis venous access failure (117 females and 71 males, aged 17–56 years) were collected. Successful innominate (brachiocephalic) venous cannulation was achieved in 149 patients (79%). Eighteen patients had successful external iliac venous approach (9%). Successful transhepatic venous approach was placed as permanent access in 7 patients (4%). The rest of the patients (n = 14, 7%) were referred to other centers due to failure. Conclusions: Sophisticated central venous approaches, mainly brachiocephalic, as described in this study, may play as alternatives for placing either temporary or tunneled hemodialysis catheters in patients with multiple vascular access failure and stenosed or thrombosed central veins.

Infections from temporary catheters in hemodialysis patients in Kosovo.

The objective of this study is to evaluate the frequency of infections from central venous temporary catheters and the type of a microorganism caused, from January 2017 up to December 2019. This study was performed on patients who were on hemodialysis (HD) through the central temporary venous catheter, right and left femoral vein, right jugular vein, and right subclavian vein.The patients in the HD center in Pristina, Kosovo, were used as a clinical sample. In this study, 1902 patients with temporarily central venous catheters (CVCs) were involved, while the control group consisted of 642 patients. Both groups were matched for age and gender. In all patients and the subjects of the control group, following data were obtained: Anamnesis, medical examination, as well as biochemical and hematological laboratory tests, CVC swab and antibiogram and hemoculture. Data analysis was performed using the descriptive statistical methods and the Chi-square test comparing the laboratory results of a HD patients treated through the central temporary venous catheter. Based on the results of this research, higher incidence of infections occurred with femoral vein access, compared to other CVCs accesses. The most common microorganisms responsible were Staphylococus epidermidis, while the 2019 had the highest incidence of infection.

Malfunctioning temporary hemodialysis catheters in patients with novel coronavirus disease 2019

ObjectiveThe hypercoagulability seen in patients with novel coronavirus disease 2019 (COVID-19) likely contributes to the high temporary hemodialysis catheter (THDC) malfunction rate. We aim to evaluate prophylactic measures and their association with THDC patency. MethodsA retrospective chart review of our institutions COVID-19 positive patients who required placement of a THDC between February 1 to April 30, 2020, was performed. The association between heparin locking, increased dosing of venous thromboembolism (VTE) prophylaxis and systemic anticoagulation on THDC patency was assessed. Proportional hazards modeling was used to perform a survival analysis to estimate the likelihood and timing of THDC malfunction with the three different prophylactic measures. We also determined the mortality, rate of THDC malfunction and its association with d-dimer levels. ResultsA total of 48 patients with a mortality rate of 71% were identified. THDC malfunction occurred in 31.3% of patients. Thirty-seven patients (77.1%) received heparin locking, 22 (45.8%) received systemic anticoagulation, and 38 (79.1%) received VTE prophylaxis. Overall, the rate of THDC malfunction was lower at a trend level of significance, with heparin vs saline locking (24.3% vs 54.6%; P = .058). The likelihood of THDC malfunction in the heparin locked group is lower than all other groups (hazard ratio [HR], 0.07; 95% confidence interval [CI], 0.01-0.45]; P = .005). The rate of malfunction in patients with subcutaneous heparin (SQH) 7500 U three times daily is significantly lower than of the rate for patients receiving none (HR, 0.03; 95% CI, 0.001-0.74; P = .032). A trend level significant association was found for SQH 5000 U vs none (P = .417) and SQH 7500 vs 5000 U (P = .059). Systemic anticoagulation did not affect the THDC malfunction rate (P = .240). Higher d-dimer levels were related to greater mortality (HR, 3.28; 95% CI, 1.16-9.28; P = .025), but were not significantly associated with THDC malfunction (HR, 1.79; 95% CI, 0.42, 7.71; P = .434). ConclusionsLocking THDCs with heparin is associated with a lower malfunction rate. Prospective randomized studies will be needed to confirm these findings to recommend locking THDC with heparin in patients with COVID-19. Increased VTE prophylaxis suggested a possible association with improved THDC patency, although the comparison lacked sufficient statistical power.

Clotting of Hemodialysis Catheters in Patients with Renal Failure with COVID-19

Clotting of Hemodialysis Catheters in Patients with Renal Failure with COVID-19

Bloodstream infections and patient survival with tunneled-cuffed catheters for hemodialysis: A single-center observational study.

In hemodialysis patients, a tunneled-cuffed permanent catheter is mandatory when the arteriovenous fistula is not feasible. The major risks of the use of tunneled-cuffed permanent catheter are bloodstream infections. The aim of this study is to analyze bloodstream infections from tunneled-cuffed permanent catheter in hemodialysis patients. An observational prospective study was carried out and 79 hemodialysis patients with tunneled-cuffed permanent catheter were enrolled. Patients were divided into those with bloodstream infections from tunneled-cuffed permanent catheter and those without. Their clinical and laboratory characteristics were compared. An original tunneled-cuffed permanent catheter lock therapy sequence was carried out combined with systemic antibiotic therapy. In case of antibiotic resistance, the tunneled-cuffed permanent catheter was removed. The patients affected by bloodstream infections from tunneled-cuffed permanent catheter were 16/79 (20.3%). The bloodstream infection from tunneled-cuffed permanent catheter's incidence rate was 0.52 per 1000 catheter days. Twenty-three bloodstream infections from tunneled-cuffed permanent catheter were found in 16/79 patients who used tunneled-cuffed permanent catheter. Staphylococcus aureus was the cause of bloodstream infection from tunneled-cuffed permanent catheter in 35% of the cases and Staphylococcus epidermidis in 30% of the cases. Risk factors were infection located in other organs and the presence of peripheral obstructive arterial disease. The enrolled cohort showed a reduced bloodstream infection from tunneled-cuffed permanent catheter incidence rate in comparison with the reference value (1 per 1000 catheter days). To reduce the number of bloodstream infections from tunneled-cuffed permanent catheter, hand hygiene and asepsis management of the tunneled-cuffed permanent catheter during the connection to the extracorporeal circuit and an original tunneled-cuffed permanent catheter lock therapy sequence seem to be the most efficient measures. Infections of other organs and the presence of peripheral obstructive arterial disease are the most important risk factors for bloodstream infections from tunneled-cuffed permanent catheter.

Cefazolin–gentamicin versus taurolidine–citrate for the prevention of infection in tunneled central catheters in hemodialysis patients: A quasi-experimental trial

BackgroundCatheter-related bloodstream infection (CR-BSI) is one of various complications related to hemodialysis (HD). As a result of the high rate of infection, the use of lock solutions for the prevention of CR-BSI has been studied. However, adverse effects of lock solution, such as increased emergence of strains resistant to antibiotics, which is an important concern, need to be investigated further. The aim of this study was to compare the efficacy of lock solution using a combination of cefazolin and gentamicin versus taurolidine and citrate in reducing CR-BSI in patients undergoing HD and to identify any adverse effects. MethodsA prospective observational study was performed at two dialysis centers. Patients using new tunneled central venous catheters (CVC) for HD were included. Patients with a tunneled CVC were assigned to receive either antibiotic lock solution (group 1: gentamicin 7mg/ml+cefazolin 12mg/ml+heparin 3500IU/ml) or lock solution with TauroLock-Hep500 (group 2: taurolidine citrate 4%+heparin 500 IU/ml) during the inter-dialysis period. The patients were allocated to these groups according to the hemodialysis center they were attending. ResultsA total of 145 CVCs were implanted in 127 patients and were followed for 15 months: 77 CVCs (65 patients) were placed in group 1 and 68 CVCs (62 patients) in group 2. There was no difference between the two groups with regard to CR-BSI (events per 1000 catheter-days: group 1=0.79, group 2=1.10; p=0.18) or exit site infection rates (events per 1000 catheter-days: group 1=2.45, group 2=1.83; p=0.37). The groups differed in ESI pathogens, with gram-positive oxacillin-resistant pathogens more frequent in group 1 (31.8% vs. 5.0%; p=0.003). The two groups were similar in mechanical complications. In the Cox regression analysis, the internal jugular vein site was a protective factor for all catheter removal complications (hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.19–0.91) and mechanical complications (HR 0.16, 95% CI 0.065–0.41); only ESI was a risk factor for all catheter removal complications (HR 1.79, 95% CI 1.04–3.07) and mechanical complications (HR 5.64, 95% CI 1.65–19.3). ConclusionsThe efficacy of both lock solutions was similar in preventing infections related to tunneled CVCs for HD. However, there were more oxacillin-resistant strains in patients who received antibiotic lock solution. Further studies are required to determine the optimal drug regimen and concentrations for lock solution and the associated adverse effects.

Studying alternative approaches for placement of cuffed hemodialysis catheters in hemodialysis patients with bilateral internal jugular vein occlusion.

Internal jugular vein occlusion often makes necessary the use of less desirable routes as external jugular, subclavian, and femoral vein approaches in addition to inferior vena cava approaches. This a prospective cross-sectional follow-up study of the alternative approaches for placement of cuffed hemodialysis catheters in end-stage renal disease patients with bilateral internal jugular vein occlusion from the interventional nephrology point of view. The study was conducted on 134 end-stage renal disease patients who were referred for insertion of a challenging hemodialysis catheter due to bilateral internal jugular vein occlusion. Ultrasound Doppler guided catheter insertion was used as a routine practice in addition to fluoroscopy or post insertion X-ray to localize catheter tip position and exclude complications. Follow-up of patients was conducted until the end of the study or catheter removal. The most highly prevalent alternative approach is the trans-external iliac vein inferior vena cava approach (43.28%) followed by external jugular vein approach (14.93%), innominate vein approach (10.18%), internal jugular vein collaterals by interventional radiology (7.46%), femoral vein approach (7.46%), transhepatic approach (5.97%), subclavian vein approach (5.22%), and finally the retrograde femoral vein approach (1.49%). End-stage renal disease patients maintained on regular hemodialysis who have bilateral internal jugular vein obstruction and non-functioning arteriovenous fistula/graft is a daily scenario in nephrology practice. Our study showed that there is a variety of approaches for the insertion of cuffed hemodialysis catheters other than occluded internal jugular veins. Interventional nephrologists have a major role in solving the problem of poor hemodialysis vascular access. These alternative approaches can conserve the anatomically limited number of percutaneous access sites in each patient.