Temporary Central Venous Catheters Research Articles

Impact of practice changes on catheter-related exit-site and bloodstream infection rates in a Canadian hemodialysis center: A retrospective study.

Hemodialysis vascular access predisposes patients to exit-site infections (ESIs) and bloodstream infections (BSIs), resulting in significant morbidity and mortality. The objective was to characterize hemodialysis catheter-related (CR) ESIs and BSIs while considering potential factors associated with infection. The study period was selected to coincide with new CR-infection prevention measures at the midpoint. These included masking during exit-site care, using chlorhexidine-alcohol versus povidone-iodine antiseptic, administering cefazolin prophylaxis with central venous catheter (CVC) insertions, and reducing temporary CVC use for chronic hemodialysis starts. Data were collected retrospectively, including patient characteristics, hemodialysis history, CVC details, and CR-infections. Quarterly infection rates were calculated per 1000 CVC days, and potential factors associated with infection were investigated. Modeling was used to characterize infection rates and covariates over time. Over 39 months, data for 267 patients, 499 CVCs, and 114,825 CVC days were captured. During the study period, there were 113 ESIs and 64 BSIs, with >80% of infections caused by gram-positive bacteria. ESI and BSI rates were 0.98 and 0.56 per 1000 CVC days, respectively. There were significant reductions in infection rates over time. The ESI rate dropped when new CR-infection prevention measures were introduced (p < 0.01), from a mean of 1.28 to 0.73 per 1000 CVC days (p = 0.003). The rate of BSI trended downward to a low of 0.10 per 1000 CVC days in the last quarter of the study. The BSI rates associated with temporary and permanent CVCs were 1.25 and 0.53 per 1000 CVC days, respectively (p = 0.1). There was a strong correlation between the declining BSI rates and declining temporary CVC use over time (rho = 0.73, p = 0.005). CR-ESI rates dropped significantly when new hemodialysis CR-infection prevention measures were introduced. CR-BSI rates declined over the study period, as did the use of temporary CVCs.

An iliac arteriovenous fistula associated with leg swelling 2 years after the removal of a hemodialysis catheter: A case report.

Temporary central venous catheters are commonly used for patients who require emergency hemodialysis. In rare instances, this procedure can result in a very serious complication known as arteriovenous fistula (AVF). Although some cases of femoral arteriovenous fistula have been reported previously in the literature; however, the incidence of iliac AVF precipitated by a hemodialysis catheter is exceedingly uncommon. The purpose of this study is to report a case in which a hemodialysis catheter caused a femoral arteriovenous fistula and to describe the successful treatment, thereby providing a reference for the diagnosis and treatment of such conditions in the future. Herein, we report the case of a patient with diabetes and end-stage kidney disease (ESKD) who presented with an iliac arteriovenous fistula as a complication of hemodialysis catheter insertion into the right femoral vein. Two years after hemodialysis catheter removal, the patient was admitted to our institution with swelling of the right lower limb and calf pain. The patient was subsequently diagnosed with an iliac arteriovenous fistula by computed tomography angiography and angiography. The patient was transferred to the Vascular Surgery Department for surgical treatment. The patient's leg swelling improved after surgery. After 1 year of follow-up, there was no occurrence of swelling in the patient's right leg. If the patient has a history of femoral venous catheter placement and develops limb swelling, in addition to considering the presence of a femoral arteriovenous fistula, it is important to consider the possibility of an iliac AVF. Iliac AVF are rare disorders. The primary goal for treatment of IAVF is to relieve associated symptoms. Based on the results of this study, the endovascular approach is safe and effective for the treatment of iliac AVF. Iliac AVFs are rare disorders. The primary goal of treatment for iliac AVFs is to relieve associated symptoms. Based on the results of this study, the endovascular approach is safe and effective in the treatment of iliac AVFs.

A Randomized Controlled Trial Comparing Automated Peritoneal Dialysis and Hemodialysis for Urgent-Start Dialysis in ESRD

Peritoneal dialysis (PD) shows promise for urgent-start dialysis in end-stage renal disease (ESRD), with automated PD (APD) having advantages. However, there is limited multicenter randomized controlled trial (RCT) evidence comparing APD with temporary hemodialysis (HD) for this indication in China. This multicenter RCT enrolled 116 patients with ESRD requiring urgent dialysis from 11 hospitals, randomized to APD or HD. Patients underwent a 2-week treatment with APD or HD via a temporary central venous catheter (CVC), followed by a maintenance PD. Outcomes were assessed over 12 months during 8 visits. The primary outcome was dialysis-related complications. The 1-year incidence of dialysis-related complications was significantly lower in the APD group than in the HD group (25.9% vs. 56.9%, P= 0.001). No significant differences were found between the groups in terms of PD catheter survival rates (P= 0.388), peritonitis-free survival rates (P= 0.335), and patient survival rates (P= 0.329). In terms of health economics, the total direct medical cost of the initial hospitalization for patients with ESRD was significantly lower in the APD group (27,008.39 CNY) than in the HD group (42,597.54 CNY) (P= 0.001), whereas the duration of the first hospital stay showed no significant difference (P= 0.424). For patients with ESRD needing urgent initiation of dialysis, APD was associated with a lower incidence of dialysis-related complications and lower initial hospitalization costs compared with HD, with no significant differences in PD catheter survival rate, peritonitis-free survival rates, or patient survival rates. These findings can guide clinical decision-making for the optimal dialysis modality for patients requiring urgent dialysis initiation.

A Modified Switching Procedure from Temporary to Tunneled Central Venous Dialysis Catheters.

Background: Tunneled central venous catheters are commonly used for dialysis in patients without a functional permanent vascular access. In an emergent setting, a non-tunneled, temporary central venous catheter is often placed for immediate dialysis. The most critical step in the catheter insertion is venipuncture, which is often a major cause for longer intervention times and procedure-related adverse events. To avoid this critical step when placing a more permanent tunneled catheter, an exchange over a previously placed temporary one can be considered. In this paper, we present a modified switching approach with a separate access site. Methods: In this retrospective analysis of a prospective database, we examined whether this modified technique is non-inferior to a de novo application. Therefore, we included all 396 patients who received their first tunneled dialysis catheter at our site from March 2018 to March 2023. Out of these, 143 patients received the modified approach and 253 the standard de novo ultrasound-guided puncture and insertion. Then, the outcomes of the two groups, including adverse events and infections, were compared by nonparametric tests and multivariable logistic regression. Results: In both groups, the implantations were 100% successful. Catheter explantation due to infection according to CDC criteria was necessary in 18 cases, with no difference between the groups (5.0% vs. 4.4% p = 0.80). The infection rate per 100 days was 0.113 vs. 0.106 in the control group, with a comparable spectrum of bacteria. A total of 12 catheters (3 vs. 9) had to be removed due to a periinterventional complication. An early-onset infection was the reason in two cases (1.3%) in the study group and five in the control group (1.9%). A total misplacement of the catheter occurred in two cases only in the control group. After adjustment for potential confounders via multivariable logistic regression there was not a significant difference in the complication rate (adjusted odds ratio, aOR = 0.53, 95% CI = 0.14-2.03, p = 0.351) but an estimated decreased risk overall based on the average treatment effect of -1.7% in favor of the study group. Conclusions: The present study shows that a catheter exchange leads to no more infections than a de novo placement; hence, it is a feasible method. Moreover, misplacements and control chest X-rays to exclude pneumothorax after venipuncture were completely avoided by exchanging. This approach yields a much lower infection rate than previous reports: 1.3% compared to 2.7% in all existing aggregated studies. The presented approach seems to be superior to existing switching methods. Overall, an exchange can also help to preserve veins for future access, since the same jugular vein is used.

Malposition of Central Venous Catheter into Coronary Sinus throughout the Persistent Left Superior Vena Cava and Other Complications Related to Catheterization.

This case concentrates on the persistent left superior vena cava (PLSVC), a rare vascular anomaly which contributes to central venous catheter (CVC) misplacement. A 72-year-old woman with renal insufficiency presented to the hospital with recurrent bleeding from her permanent CVC device placed in the right common jugular vein. An initial attempt to replace the device was unsuccessful, necessitating the placement of a secondary catheter in the left jugular vein. Shortly after the procedure, the patient developed swelling of the face and neck. Further diagnostic imaging, including a chest radiograph and computed tomography (CT), revealed CVC misplacement in the PLSVC and coronary sinus, thrombosis of the common jugular vein, and a posterior mediastinal hematoma. Conservative therapy of the mediastinal hematoma was implemented and proved effective in this case. A temporary CVC was inserted into the left femoral vein. Two months later, the catheter underwent further dysfunction and a decision was made to place a long-term permanent CVC via the right femoral vein. The patient is currently awaiting an arteriovenous fistula for dialysis use. This case emphasizes the importance of radiological techniques for CVC procedural placement, as well as the detection of congenital abnormalities. Providers regularly placing CVCs should have an in-depth knowledge of the possible complications and potential anatomical variations, especially as seen in high-risk patients.

The Effect of Residence Time of No-tunneled Hemodialysis Catheters on Infection and Thrombosis Outcome. Identification of CVC’s Time Cut-off

Introduction: Permanent vascular access (arteriovenous fistula (AVF), arteriovenous graft (AVG)) is susceptible to acute events that reduce patency. The temporary central venous catheter (CVC) constitutes bridging therapy for primary vascular access dysfunction. The impact of “residence time” on the rate of dysfunction/thrombosis or infection remains to be explored. AIM: 1) To evaluate the impact of CVC residence time on outcomes (infection or Thrombosis/dysfunction) in consecutive temporary CVCs adjusted for the insertion site (upper site vs. lower site). 2) To establish a cut-off resident time. Patients and methods: Seventeen prevalent hemodialysis patients with three consecutive CVCs are followed up prospectively in an observational study for a period equivalent to the permanence of the CVCs. The data is recorded at the beginning of the CVC time. The diagnosis of catheter-related bloodstream infection and thrombosis/dysfunction is made following the K-Doqi 2019 guidelines. Statistical analysis: Seventeen hemodialysis patients (51 CVCs) were included. The ‘CVC resident time’ of each individual patient ((i.e. βcoefficient (log-transformed)*AUC)) was determined using LMM and then inserted into multivariate Cox models to assess infection and dysfunction/thrombosis outcomes (Joint Models). The AUC was calculated at various baseline levels of CVC time (10th……50th percentile). The cut-off point for thrombosis in CVC time corresponds to the mean of the CVC time at the 30th percentile of all CVCs. Results: The CVC time is different for CVC’s site insertion and sequence. From the analysis of multivariate joint models, CVC resident time appears not to be significant for infection, but heterogenicity for the insertion site (ref3-4=upper site) is significant for the outcome of thrombosis/dysfunction. From the study of survival analysis, the free survival from outcomes by CVC site insertion appears to be significant for thrombosis/dysfunction. The average time of CVCs’ calculation at the 30th percentile is 14 days (cut-off). Conclusion: No tunneled hemodialysis Catheter (NTHC) residence time is considered not to be a risk factor for infection, but it represents a risk factor for lower access thrombosis. After the cut-off time of 14 days, the advantage of the higher NTHCs is lost.

Improving assessment and escalation of threatened haemodialysis access: results of a nursing-led program

BackgroundOptimal vascular access is critical to successful haemodialysis. Acute thrombosis of haemodialysis access often leads to unplanned hospital admissions and interventions to restore patency.Western Health is a large health service in Victoria, Australia. During the period February 2019 to January 2020, the rate of arteriovenous fistula (AVF) and arteriovenous graft (AVG) at Western Health satellite dialysis units was 0.33 episodes per 1000 patient-days, higher than the reported rate in the literature of 0.24 events per 1000 patient-days, and was associated with a cumulative total of 139 days of inpatient stay (2.2 per 1000 patient-days).MethodsThe above results prompted creation of an education and escalation pathway for threatened haemodialysis access, based upon clinical markers of vascular access stenosis or imminent thrombosis assessed by nursing staff in satellite haemodialysis centres.In the period February 2020 to January 2021, the education and escalation pathway was implemented. We assessed referrals via the pathway, rates of AVF/AVG thrombosis and associated hospital length of stay in the following 12-month period (February 2021 to January 2022).ResultsFollowing introduction of the pathway, rates of AVF/AVG thrombosis declined to 0.15 per 1000 patient-days (p = 0.02), associated with a decline in attributable cumulative inpatient stay to 55 days (0.69 per 1000 patient-days).ConclusionsOur program demonstrates that the majority of thrombosed vascular access can be predicted and potentially averted with vigilant and well-practiced routine clinical assessment by trained nursing staff. Our nursing-led education and escalation program successfully identified vascular access at risk of imminent thrombosis, reduced rates of acute thrombosis and associated healthcare costs.Despite these improvements, there are still disparities in outcomes for patients with thrombosed vascular access, with regards to length of stay and requirement for insertion of a temporary central venous catheter (CVC) for urgent dialysis whilst awaiting intervention, and these are areas for further investigation and improvement.

#5103 VASCULAR ACCESS AT HEMODIALYSIS INITIATION: A REPORT FROM THE ROMANIAN RENAL REGISTRY

Abstract Background and Aims Vascular access (VA) type used at hemodialysis (HD) initiation varies greatly across countries and dialysis providers, and central venous catheters (CVC) usage is associated with poor survival. Since middle 2019, the Romanian Renal Registry (RRR) imposed compulsory reporting for VA. Therefore, we aimed to evaluate at a national level the VA at HD initiation and its impact on survival. Method We examined the outcome on September 30, 2022, in incident patients starting HD between January 1, 2020 and December 31, 2021. RRR records data on patient age, sex, primary kidney disease (PKD), history of kidney replacement therapy (KRT) and VA, date and cause of death. Results A total of 6153 patients (median age 65 (IQR 54, 72) years, 60% male) started HD in the study period. Glomerulonephritis, diabetic kidney disease (DKD) and tubulointerstitial disease were the main PKD (12, 11 and 9%); the diagnosis was unknown in almost half of the patients (47%). Only 15% of the patients started HD on arterio-venous fistula (AVF); CVC was used in most of the patients: 63% temporary and 22% tunnelled. As in the first 90 days of the study 1674 patients died (74%), recovered the kidney function (17%), received a kidney transplant (2%) or were lost to follow up (7%), the final cohort for survival analysis (i.e. patients that survived more than 90 days) included 4479 patients. The proportion of VA type at HD initiation was similar in this cohort: only 20% AVF, 58% temporary and 23% long-life CVC. A total of 664 (15%) patients died after the first 90 days. They were older, had more often DKD and more frequently started HD on CVC. Cardiovascular disease (56%) was the main cause of death, followed by infectious (14%), cancer (6%), neurological (5%) and gastroenterological (2%) causes. There were no differences in the causes of death between patients who started HD on AVF or CVC. The mean survival time for the entire cohort was 25.3 (95%CI, 25.0-25.6) months. Survivals at 6, 12 and 24 months were 93%, 88% and 80%. In univariate analysis, patients who started HD on AVF had a significantly better mean survival time than those starting on temporary or on tunnelled CVC: 26.6 (95%CI, 26.2-27.1) vs. 25.1 (95%CI, 24.8-25.5) and 24.6 (95%CI, 24.0-25.2) months. In the multivariate Cox proportional hazard model, higher age at HD initiation, DKD, and CVC as initial VA were significantly associated with a poorer survival (Table 1). We reexamined the VA at 6 months after HD initiation - on December 31, 2021, or at the last treatment recorded – in 5654 patients. At six months from HD initiation, 33% were using an AVF, 39% a tunnelled, and 28% a temporary CVC. Conclusion In this nationwide, registry-based study we observed a high rate of CVC usage (80%) among incident HD patients. Also, there was a low conversion from CVC to AVF, with only 33% of patients having a patent AVF six months after HD initiation. HD initiation on a CVC was independently associated with a higher mortality. Furthermore, close to a half of the studied patients had unknown PKD. Taken together, these data point to late nephrology referral of patients in stage 4 CKD, and deficient predialysis nephrology care. A national strategy should be implemented to improve CKD care, aiming to increase both the rate of AVF usage at HD, and the conversion from CVC to AVF in the six months.

Paradigms of megapolis nephrology in a changing world: status, problems and prospects of development of the nephrological service of St. Petersburg

The course of the COVID-19 pandemic has led to a critical increase in the burden on virtually all major branches of the health care system in our country and abroad. The aim of this article is to analyse the activities of the different parts of the city nephrol­ogy service in Saint-Petersburg and to consider promising ways to improve it. The nephrology service for the adult population in St. Petersburg includes: outpatient service; inpatient service - 183 beds in 24-hour inpatient departments of the city; dialysis service - 10 dialysis units in municipal medical organizations, 5 in federal institutions, and 8 centers/departments operating in the framework of private-public partnership. The number of patients on dialysis programme decreased by 10.5 % to 1,839 in 2021. These changes are likely due to an increase in mortality among these patients in 2020 and 2021 which is a consequence not only of COVID-19 but also of the adverse impact of the pandemic on the health system. The proportion of patients treated as outpatients in private dialysis centres increased during the three-year period. The incidence of arteriovenous fistula formation in primary vascular access decreased from 33.2 % to 14.2 % in 2020 compared with 2019. At the same time, the use of temporary central venous catheters as primary vascular access for renal replacement therapy has increased significantly from 43.0 % to 61.9 %. The development of the nephrology service is largely determined by its funding. To compensate the costs of medical in­ stitutions in the city for conducting renal replacement therapy it is necessary to increase the tariffs of compulsory health insurance (CHI) by at least 50 %. In the medical organizations of Saint-Petersburg municipal and federal subordination the share of "artificial kidney" devices that have used up their resource is 32.2 %, and in a number of medical institutions it exceeds 50 %.

Is minimising waste volume for drawing blood samples in critically ill patients feasible?

IntroductionDrawing blood samples through a central venous catheter (CVC) is a customary practice in Intensive Care Units (ICUs). It is indicated to discard a volume of waste blood to avoid interference in the results. AimTo determine whether a lower discard volume for obtaining blood samples from temporary CVCs placed into the internal jugular, femoral or subclavian vein offers valid results. MethodA quasi-experimental prospective cross-sectional study for which sixty-five patients of over 18 years of age in ICUs, who had been fitted with a triple lumen central venous catheter, were recruited over a period of eight months. Two consecutive blood samples were extracted with tubes for biochemistry, coagulation and hemogram from each patient from the distal lumen. The first sample was obtained with a discarded waste of 1.5 ml from a total extracted volume of 10.2 ml, similar to the usual waste in our ambit (10 ml). Subsequently the second sample was obtained. The paired t-test was used to analyse the data. The Bland-Altman plot and intraclass correlation coefficient (ICC) were used to measure the agreement between methods. The reference change value (RCV) was established as the admissible limit of variation between the pairs of samples. ResultsA total of 65 sample pairs were drawn (intervention-control). The paired t-test found statistically significant differences with a significance level of α = .05 for chlorine (−.536; .012); prothrombin time (−.092; .019) and prothrombin activity (.284; 1.375).The ICC was greater than .9 in all the variables and the limit determined for the RCV was not surpassed by any value. ConclusionsThe results show the reliability of the blood samples drawn with a discard volume of 1.5 ml.

Minimizar el volumen de descarte para la extracción de muestras sanguíneas en los pacientes críticos: ¿es factible?

IntroductionDrawing blood samples through a central venous catheter is a customary practice in intensive care units. It is indicated to discard a volume of waste blood to avoid interference in the results. AimTo determine whether a lower discard volume for obtaining blood samples from temporary central venous catheters placed into the internal jugular, femoral or subclavian vein offers valid results. MethodA quasi-experimental prospective cross-sectional study for which 65 patients of over 18 years of age in intensive care units, who had been fitted with a triple lumen central venous catheter, were recruited over a period of 8 months. Two consecutive blood samples were extracted with tubes for biochemistry, coagulation and haemogram from each patient from the distal lumen. The first sample was obtained with a discarded waste of 1.5ml from a total extracted volume of 10.2ml, similar to the usual waste in our ambit (10ml). Subsequently the second sample was obtained. The paired t-test was used to analyse the data. The Bland-Altman plot and intraclass correlation coefficient were used to measure the agreement between methods. The reference change value was established as the admissible limit of variation between the pairs of samples. ResultsA total of 65 sample pairs were drawn (intervention-control). The paired t-test found statistically significant differences with a significance level of α=0.05 for chlorine (−0.536; 0.012); prothrombin time (−0.092; 0.019) and prothrombin activity (0.284; 1.375). The intraclass correlation coefficient was greater than 0.9 in all the variables and the limit determined for the reference change value was not surpassed by any value. ConclusionsThe results show the reliability of the blood samples drawn with a discard volume of 1.5ml.

Pattern of vascular access-related infection in hemodialysis patients

Background Vascular access-related infections (VARI) represent a substantial burden for patients undergoing hemodialysis (HD) that is unfortunately inevitable. The spectrum of causative organisms varies between different regions and centers, so it is necessary for each dialysis unit to have its database. This prospective descriptive multicenter study was conducted over a 6-month duration to delineate the pattern of VARI among patients undergoing HD units of Alexandria University Hospitals, and to determine the possible relationship between VARI, type of vascular access, pattern of causative organisms, and various risk factors. Materials and methods The study enrolled all patients with documented clinical and bacteriological evidence of VARI. Infection incidence-rate event/1000 dialysis session (ds) was calculated. Results During the study period, 877 HD patients were approached. A total of 66 VARI episodes were identified in 62 patients, with 58 bloodstream infection (BSI) episodes and 8 local-access infections, with an overall incidence rate of 4.64/1000 ds. About 64% of isolated organisms were Gram-negative bacilli, 33.3% Gram-positive cocci, and 2.8% fungi. The most frequent isolated pathogens were Klebsiella pneumonia, Escherichia coli, and methicillin-resistant Staphylococcus aureus (MRSA). Conclusion VARI rate was higher in HD patients with temporary central venous catheter compared with permanent tunneled catheters. Gram-negative microorganisms and MRSA were the most frequent identified organisms. Creation of arteriovenous fistula should not be delayed to avoid the use of temporary catheters, which carry high risk of VARI.

Survival of patients on chronic hemodialysis versus chronic peritoneal dialysis.

To compare the survival of patients with chronic kidney disease (CKD) on hemodialysis (HD) versus peritoneal dialysis (PD). Survival analysis of a retrospective cohort of patients ≥ 18 years who started HD versus PD at the Victor Lazarte Echegaray Hospital from 2015 to 2019. We analyzed the following covariates: age, sex, diabetes mellitus as cause of CKD, temporary central venous catheter (CVC) as initial vascular access and glomerular filtration rate. Survival was calculated with Kaplan-Meier curves for the overall cohort and for age ≥ 60 years, diabetes mellitus as a cause of CKD and CVC. The risk of death was estimated by Hazard Ratio (HR) according to the Cox proportional hazards model for each covariate adjusted for dialysis type in a bivariate and multivariate analysis considering significant difference if the p-value < 0.05. We included 368 patients on HD of whom 129 (35.1%) died, and 172 patients on PD of whom 66 (38.4%) died (p=0.455). The cumulative probability of survival at 60 months for HD was 30% and for PD was 37% with similar survival curves (p=0.719). The median survival time for HD was 32 months (IQR: 20-53) and for PD was 32.5 months (IQR: 18-57) (p=0.999). The covariates associated with higher mortality adjusted for dialysis type were age ≥60 years (HR 1.77; p<0.001) and diabetes mellitus as a cause of CKD (HR 1.63; p=0.002). Survival of patients with CKD on HD and PD was similar.

The effect of the multimodal intervention including an automatic notification of catheter days on reducing central line-related bloodstream infection: a retrospective, observational, quasi-experimental study

BackgroundA central venous catheter (CVC) is an important medical device, but it could be preceding infection and the risk of central line-associated bloodstream infection (CLABSI). CLABSI is a common healthcare-associated infection but results in high cost and mortality; therefore, various efforts to reduce CLABSI have been attempted.MethodsThis is a retrospective, observational, quasi-experimental study in the intensive care unit (ICU) of a single tertiary care hospital. We reviewed and analysed the data of CLABSI rates and days from the insertion to the removal of the temporary CVC between January 2018 and June 2021 with transient periods over 9 months. Sequentially, all patients with the CVC in the ICU underwent the following interventions: maximal barrier precaution, automatic notification of catheter days and 2% chlorhexidine gluconate bathing. A segmented regression analysis of interrupted time series was conducted to compare the CLABSI rates before and after the introduction of multimodal interventions. During study periods, the impact of interventions on CLABSI was evaluated using multivariate logistic regression analyses.ResultsA total of 76,504 patient-days, 28,312 catheter days and 66 CLABSI cases were reviewed in ICU-hospitalised patients. As additional interventions, the CLABSI rate declined from 3.1 per 1000 CVC days to 1.2 per 1000 CVC days in post-interventions. In the pre-intervention and post-intervention periods, 4146 patents had one more short-term CVC. In the multivariate logistic regression analyses, multimodal intervention was one of determinants reducing CLABSI rates (odds ratio (OR), 0.52 [95% confidence interval {CI}, 0.28–0.94]). Indwelling time of CVC over 10 days was the risk factor for CLABSI rates (OR, 6.27 [95% CI, 3.36–12.48]). Of the three interventions, the automatic notification of catheter days was associated with decreased median monthly total CVC days and duration of CVC days per patient.ConclusionsMultidisciplinary and evidence-based interventions could lead to a decrease in the CLABSI rates. Moreover, the automatic notification of catheter days of the electronic medical healthcare system has shortened the time of indwelling CVC.

The effectiveness of a dedicated central venous access care team to prevent catheter-related bloodstream infections

Background: Catheter-related bloodstream infection (CRBSI) rates remain high despite the use of an insertion bundle. We hypothesized that line care and maintenance by a dedicated team would help decrease CRBSI rates. This study was conducted in The Medical City (TMC), is a 526-bed, private, tertiary-care center in Pasig City, Philippines. Methods: All adult hospitalized patients from October 1, 2020, to October 31, 2021, with a newly inserted temporary central venous catheter (CVC) were eligible for inclusion. CRBSI rates before the intervention (October 2019 to March 2020) and after the intervention (April to October 2021) were compared. The intervention arm consisted of a dedicated central venous access team (CVAT) who provided education and performed daily line care and dressing changes per protocol. A series of χ2 and Wilcoxon rank-sum tests were performed to compare characteristics between exposure groups. Incidence rates of CRBSI before and after the intervention were compared using an incidence rate ratio approach. Results: In total, 209 CVCs were enrolled in the study, with 103 CVCs (49.28%) in the preintervention arm and 106 CVCs (50.72%) in the postintervention arm. Baseline patient characteristics were similar. CRBSIs were more frequent in the preintervention arm than the postintervention arm (39 of 103 vs 28 of 106; P = .08). The CRBSI incidence density rate was higher in the preintervention arm than the postintervention arm, but the difference was not statistically significant (37.46 per 1,000 patient days vs 25.97 per 1,000 patient days; P = .14). Median time to CRBSI was similar in both groups (9 vs 8 days). Conclusions: Baseline CRBSI rates were high and risk of infection increased by day 8 after line insertion. We detected a decreasing trend in rates of CRBSI with a dedicated CVAT, but multiple interventions are likely needed to influence overall rates.Funding: NoneDisclosures: None

MO764: Type of Vascular Access in Incident Hemodialysis Patients in Morocco: Predialysis Nephrology Care Should be Improved

Abstract BACKGROUND AND AIMS Current guidelines recommend early placement of an autogenous arteriovenous fistula (AVF) before initiation of chronic hemodialysis therapy. Also, several studies showed that optimal pre-dialysis care is crucial to prepare a functioning permanent dialysis access. However, despite these recommendations, incident patients in Morocco usually initiate dialysis therapy using temporary catheters. Therefore, the purpose of our study was to identify the types of vascular access used by incident hemodialysis patients in Morocco and to determine the effect of pre-dialysis renal care on native AVF utilization. METHOD We conducted a cross-sectional study at the nephrology department of Mohammed VI university hospital from January 2019 to January 2021 among adult incident hemodialysis patients. Clinical and demographic characteristics, as well as data on vascular access type and nephrology care prior to dialysis initiation, were recorded. RESULTS A total of 210 patients were enrolled in our study. The mean age of the participants was 51.6 ± 12.3 years (19–78) with a male predominance (71.4%). The leading cause of the end-stage renal disease (ESRD) was diabetic nephropathy in 41.4% of the patients. At hemodialysis therapy initiation, 173 patients (82.4%) were dialyzed using a temporary central venous catheter (CVC), 20 (9.5%) with a tunneled hemodialysis catheter (TDC) and 17 (8.1%) with an AVF. Out of all participants, only 81 (38.5%) received prior nephrology care. Patients who reported being seen by a nephrologist at least 1 month before starting hemodialysis therapy (75%) were more likely than those referred later to use an AV access at initiation (22.2% versus 1.5%; P &amp;lt; 0.001). This association remained significant after adjustment for age, sex, geographical origin, education, insurance coverage, comorbidity status and underlying renal diagnosis. CONCLUSION Our findings showed a high incidence of CVC use among incident hemodialysis patients which is contrary to all recommendations. Also, we found that patients who received pre-dialysis nephrology care were significantly more likely to start their HD through AVF. Therefore, further efforts to improve both referral patterns and preparation for dialysis after referral are needed.

MO775: Vacuum-Assisted Thromboaspiration with Indigo System After Acute Arteriovenous Fistula Thrombosis: Monocentric Experience of an Innovative Interventional Approach

Abstract BACKGROUND AND AIMS Arteriovenous fistula (AVF) must be the first choice where eligible and a prompt approach within 48–72 h should be performed in case of acute AVF failure in order to maintain the patency of the vascular access. Evaluation of the most appropriate de-clotting technique must be made considering the patient's comorbidity, AVF characteristics and absolute, relative and temporary contraindications to each kind of corrective intervention. The outcome is different between the multiple methods and nowadays mechanical thromboaspiration (MT) seems to be an innovative and promising approach. METHOD A total of 9 AVF of 9 chronic haemodialysis patients with acute AVF failure were treated with MT between January 2019 and January 2022 and were retrospectively evaluated. MT was carried out via Indigo catheter (Penumbra Inc.), an aspiration system intended for the removal of emboli and thrombi from vessels through venipuncture of AVF/AVG: the continuous aspiration helps distinguish clots from normal blood flow; in case of resistant clots, separators of many sizes can be used at the tip of the catheter to facilitate their fragmentation and aspiration. Adjunctive procedures such as balloon angioplasty (used at all sites), local fibrinolysis, heparin infusion, or stents placement were considered. Technical success was defined by clot removal from AVF or AVG. Clinical success was defined by the restoration of thrill and bruit together with AVF usability after the procedure. Vascular access survival defined as AVF/AVG usability at 3 and 6 months was assessed. RESULTS Average age was 71.2 years; dialysis vintage was 93.4 months. Medium follow-up was 13.1 months. All patients needed placement of a temporary central venous catheter (CVC) and dialysis before the MT. Technical success was achieved in 100% of the procedures, clinical success was achieved in 88.9% of the MT (despite the technical success, in 1/9 patients AVF could not be used due to a severe residual venous stenosis). None reported peri-/intraprocedural complications. In 2/9 MT there was no use of anticoagulation; in 5/9 patients, a single unfractionated heparin bolus was used (2500 UI) during the manoeuvre; in 2/9 patients, a single 2500 UI bolus plus continuous intravenous infusion of unfractionated heparin was administered combined with local thrombolysis with urokinase: both patients needed blood transfusions after the manoeuvre, one of them reporting severe haemorrhage from AVF. As adjunctive procedures, 9/9 patients underwent balloon angioplasty; one of them needed stent placement over the venous stenosis. CVC was removed less than 48 h from the procedure in 5/9 patients (55.6%), in 3/9 patients it was removed after 48 h, while 1/9 patients maintained the temporary vascular access due to the lack of clinical success after MT. Double-needle puncture occurred after a medium time of 3.5 days. AVF survival at 3 months and 6 months was 66.6% (6/9 patients), while 3/9 patients faced AVF failure (1/3 patients deceased 2 months after the procedure with a functioning AVF, in 1/3 patients a relapse of AVG thrombosis occurred 2 months after the procedure, 1/3 never reached clinical success due to severe residual venous stenosis). At the time of study design, 3/9 patients resulted to be deceased due to causes unrelated to the procedure. (1/3 due to complications of abdominal surgery, 1/3 due to sepsis, 1/3 due to subarachnoid haemorrhage). CONCLUSION MT is an innovative yet functional and safe procedure that allows declotting of the thrombosed AVF while reducing or avoiding anticoagulation and/or surgery.

MO1028: Vascular Access Type in Haemodialysis Paediatrics Patients—From Central Venous Catheter to Arteriovenous Fistula

Abstract BACKGROUND AND AIMS Haemodialysis (HD) in children has become progressively more used, the efficiency of the treatment, as well as the technical improvements, are evident. Permanent access in the form of a fistula is the preferred type of vascular access (VA) for most paediatric patients on maintenance HD. However, age-related anatomical limitations, shorter waiting times for transplantation, or lack of paediatric/surgical expertise limit its use. Central venous catheter (CVC) remains the most used access in children. Here we present the results of the last 14 years of experience in paediatric HD vascular access from a reference centre in northern Portugal. METHOD A retrospective descriptive study of patients admitted to our paediatric HD Unit between January 2007 and December 2021. Clinical data were collected from medical records. RESULTS In total 46 patients were enrolled, mainly boys (n = 26, 56.5%), mean age at admission 10.8 + 5.3 years (1–17), 39.1% weighing ˂ 30 kg (n = 18) and 17.4% ˂15 kg (n = 8). More than half were incident patients starting on HD (n = 25, 54.3%), 45.7% (n = 21) were transferred from peritoneal dialysis (PD) and one patient had a previous kidney transplant (KT). Regarding CKD etiology, 52.2% (n = 24) were mainly due to congenital anomalies of the kidney and urinary tract; chronic glomerulonephritis was responsible for 19.6% of cases (n = 9). Most patients started HD with a CVC (n = 38, 82.6%), including two patients with an arteriovenous fistula (AVF) who required a temporary CVC until fistula maturation. At the end of follow-up, about 43.5% (n = 20) of the patients ended up with an AVF (compared with 17.4% at the beginning) and, not surprisingly, 90% (n = 18) of them weighed ˃ 30 kg and only one child ˂ 15 kg. The mean duration of dialysis was 1.1 + 0.5 years (1 month–8 years); 28 patients were submitted to KT (60.9%), 7 transferred to PD (15.2%) and 4 (8.7%) remain on HD. Average waiting times for KT are quite longer in patients with AVF (1.56 years), in comparison to CVC (0.584 years). CONCLUSION In children, choosing the best vascular access remains a challenge. CVCs continue to be the most used type of vascular access. This option can be justified by the limitations of smaller patients, the expectation of a short waiting time for KT and the need to cannulate every other day (with the pain and fear associated with it). CVCs were associated with less effective dialysis and higher complication rates. On the other hand, AVFs have shown excellent long-term patency in paediatric HD patients. In our group, no significant complications were reported and no thrombosis occurred.

POS-646 TYPE OF VASCULAR ACCESS IN INCIDENT HEMODIALYSIS PATIENTS IN MOROCCO: PREDIALYSIS NEPHROLOGY CARE SHOULD BE IMPROVED

Current guidelines recommend early placement of an autogenous arteriovenous fistula (AVF) before initiation of chronic hemodialysis therapy. Also, several studies showed that optimal predialysis care is crucial to prepare a functioning permanent dialysis access. However, despite these recommendations, incident patients in Morocco usually initiate dialysis therapy using temporary catheters. Therefore, the purpose of our study was to identify the types of vascular access used by incident hemodialysis patients in Morocco and to determine the effect of predialysis renal care on native AVF utilization. We conducted a cross-sectional study at nephrology department of Mohammed VI university hospital from January 2019 to January 2021 among adult incident hemodialysis patients. Clinical and demographic characteristics, as well as data on vascular access type and nephrology care prior to dialysis initiation were recorded. A total of 210 patients were enrolled in our study. The mean age of the participants was 51.6 ±12.3 (19-78) with a male predominance (71.4%). The leading cause of ESRD was diabetic nephropathy in 41.4% of the patients. At hemodialysis therapy initiation, 173 patients (82.4%) were dialyzed using a temporary central venous catheter (CVC), 20 (9.5%) with a tunneled hemodialysis catheter (TDC) and 17 (8.1%) with an AVF. Out of all participants, only 81 (38.5%) received prior nephrology care. Patients who reported being seen by a nephrologist at least 1 month before starting hemodialysis therapy (75%) were more likely than those referred later to use an AV access at initiation (22.2% versus 1.5%; P < 0.001). This association remained significant after adjustment for age, sex, geographical origin, education, insurance coverage, comorbidity status and underlying renal diagnosis. Our findings showed a high incidence of CVC use among incident hemodialysis patients which is contrary to all recommendations. Also, we found that patients who received predialysis nephrology care were significantly more likely to start their HD through AVF. Therefore, further efforts to improve both referral patterns and preparation for dialysis after referral are needed.

Rates of Neutropenic Fever in Patients with Hematologic Malignant Diseases with Central Venous Access

Background: Patients who are diagnosed with hematologic malignant diseases (HMD) almost invariably receive placement of central venous catheters (CVCs), whether temporary or permanent. These catheters are used for administration of various chemotherapies, antibiotics and even nutrition. Although the patients with HMD are immunocompromised, prophylactic use of antibiotics among these patients, especially related to CVC placement, remains controversial. This retrospective analysis evaluates the rates of development of neutropenic fever in patients with HMD with CVCs receiving prophylactic antibiotics.Methods: Data were collected retrospectively in a cohort of 268 patients with HMD who received treatment at our academic institution between 2002 to 2019. Demographic and other related data was abstracted and descriptive analysis was performed using Epi-Info - 7 software.Results: Of the 268 patients with HMD, 175 patients (65.3%) received prophylactic antibiotics and among these patients, 180 (67.2%) had a permanent CVC and 109 (40.7%) had a temporary CVC. Comparatively, 93 patients (34.7%) did not receive prophylactic antibiotics and among these individuals, 64 (68.8%) had a permanent CVC and 34 (36.6%) had a temporary CVC. In patients with a permanent central line, 84.3% of patients receiving prophylactic antibiotics developed neutropenic fever while 85% of those who did not receive prophylactic antibiotic also developed neutropenic fever. Among the individuals with a temporary CVC, 79.7% of patients receiving prophylactic antibiotics developed neutropenic fever and 65.4% of patients who were not receiving prophylactic antibiotics also developed neutropenic fever. None of the differences were statistically significant (p=0.8990 and p=0.1547 respectively).Conclusion: In this cohort of HMD patients, the rate of neutropenic fever development in patients with central venous access receiving prophylactic antibiotic was not significantly different compared to the rate of neutropenic fever development in patients with central venous access who did not receive any prophylactic antibiotic. This data suggests that there does not appear to be a significant clinical utility for prophylactic antibiotics in the prevention of neutropenic fever in patients with HMD who have central venous catheters in place. Further studies analyzing the impact of prophylactic antibiotics on true infections as an etiology for neutropenic fevers in patients with HMD and central venous catheters is warranted. DisclosuresNo relevant conflicts of interest to declare.