Tunneled 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

Re-Establishment of Vascular Access After Superior Vena Cava Occlusion in Hemodialysis Patients

To evaluate the application of percutaneous right atrial puncture and tunneled cuffed catheter insertion and the establishment of peripheral arteriovenous (AV) access in hemodialysis patients with superior vena cava occlusion (SVCO), and to provide evidence-based support for the re-establishment of vascular access in patients with limited vascular resources. Patients with SVCO were enrolled. Then, either right neck percutaneous puncture catheterization or peripheral AV access construction was performed on the patients according to their personal preference. The patients were divided into the catheter group and the AV access group accordingly. Under the guidance of double C-arm digital subtraction angiography, a puncture was made in the right brachiocephalic vein or the stump of superior vena cava. Portal venous shunt instrument RUPS100 was then inserted through the guide wire, and the hard end of the guide wire was used to puncture the right atrium to achieve sharp recanalization of the occlusive superior vena cava. Afterwards, balloon expansion of the obstructive superior vena cava lesion and the subsequent implantation of the tunneled-cuffed catheter were performed. In AV access group, after evaluating the collateral veins by venougraphy and the peripheral vessel by ultrasound, autologous AV fistula or graft was established according to the vascular conditions of the patient and their personal preferences. The demographic information and clinical outcomes, such primary and primary assisted patency of access, were documented and the incidence of complications was monitored. With the duration of patent access defined as the survival time, Kaplan-Meier survival analysis was performed to compare the patency rates of the two groups. A total of 45 SVCO patients were enrolled and underwent re-establishment of vascular access. Among them, 21 cases were in the catheter group and 24 cases were in the AV access group. All patients had their vascular access successfully constructed and received hemodialysis, and no relevant complications or deaths occurred during the procedure. Over the mean follow-up period of (471.22±125.94) days, the primary patency rates in the catheter group 95.2% and 85.7% at 6 and 12 months, respectively, and the primary assisted patency rates were 100% and 95.2%, respectively. The primary patency rates of the AV access group were 79.2% and 62.5% at 6 and 12 months, and the primary assisted patency rates were 95.8% and 87.5%, respectively. No significant difference was observed between the two groups. Kaplan-Meier survival analysis showed that the median survival time (defined as the duration of patent access) was 670.00 (468.99, 871.01) days in the catheter group and 450.00 (339.24, 560.76) days in the AV access group, with the catheter group outperforming the AV access group. The primary patency rate of the catheter group was better than that of the AV access group (P=0.049). On the other hand, no significant difference was observed in the primary assisted patency rates of the two groups. Long-term vascular access can be established for SVCO patients by either percutaneous catheterization through the right atrium of superior vena cava stump or the establishment of peripheral AV access. The comprehensive plan, which includes the establishment of AV access first and the subsequent catheterization, is expected to improve the total duration of long-term vascular access and prolong the overall survival of dialysis patients, which provides new ideas for re-establishing dialysis access in patients with exhausted central venous resources.

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.

New-onset atrial fibrillation following arteriovenous fistula increases adverse clinical events in dialysis patients with end-stage renal disease.

End-stage renal disease (ESRD) patients have a high potential cardiovascular burden, and cardiovascular disease (CVD) is the leading cause of death in maintenance haemodialysis (MHD) patients. Arteriovenous fistula (AVF) is the preferred vascular access for MHD patients, but AVF significantly affects the haemodynamics of the cardiovascular system, leading to or exacerbating CVD, including atrial fibrillation (AF). This study aimed to evaluate the impact of AVF on cardiac function, especially of the left atrium (LA), in patients with ESRD and to further explore the relationship between AVF establishment and the occurrence of AF. We selected 1,107 ESRD patients on haemodialysis using AVF and 550 patients with tunneled-cuffed catheters (TCC) admitted between January 2016 and December 2022 for follow-up to compare the rate of AF between the two groups. A total of 153 patients in the AVF group with complete information (clinical data, echocardiographic and biochemical indices, and other data) were enrolled and retrospectively analysed for risk factors for the development of AF and were followed up for adverse clinical outcomes (including all-cause death, cardiac death, readmission due to heart failure, and stroke). The incidence of new-onset AF was higher in the AVF group than the TCC group after dialysis access was established (16.30% vs. 5.08%, P < 0.001). Echocardiography showed that the LA anteroposterior diameter increased (P < 0.001) and the incidence of AF increased from 11.76% to 26.14% (P = 0.001) after AVF establishment. Multivariate logistic regression analysis showed that age and LA enlargement were independent risk factors for new-onset AF after AVF establishment (P < 0.05). Adverse clinical outcomes were more common in patients with AF than in patients without AF (P < 0.001). Multivariate Cox risk regression analysis suggested that new-onset AF (HR = 4.08, 95% CI: 2.00-8.34, P < 0.001) and left ventricular systolic dysfunction (HR = 2.42, 95% CI: 1.20-4.88, P = 0.01) after AVF establishment were independent risk factors for adverse clinical outcomes. LA enlargement after AVF establishment is associated with a significant increase in the incidence of AF, in addition, AF which is as an important influential factor in patients with MHD combined other systemic diseases might increase adverse clinical events. (NCT06199609).

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.

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.

Guidewire replacement of valved tunneled-cuffed silicone catheters with power injectable polyurethane tunneled-cuffed catheters or with ports.

Silicone Cuffed Centrally Inserted Central venous catheters (CICCs) were a type of catheters that have been used for a long time especially in cancer patients. Recently, thanks to biomedic research progresses, polyurethane catheters have resulted in higher surgical performances compared to classical silicone ones. Indeed, the inferior calibers of these new catheters lead to an extremely faster infusion rate. The presence of a valve at the tip of the catheter could suggest an impossible replacement procedure over a Seldinger guidewire. The aim of this article is to explain our replacement technique over guidewire of silicone cuffed and valved tunneled CICCs with a power injectable polyurethane cuffed tunneled CICC. The casistic presented was evaluated at the Vascular Access Unit of ASST Spedali Civili in Brescia, Italy. The study involved 35 successful catheter replacement over guidewire, meanwhile cases where patients presented sepsis, exit site infection, or catheter damage were premeditatedly excluded. The maneuver was always conducted following the same procedure without noticing particular complications associated with CICC insertion. Indeed, the operation was quick, feasible, and safe. Septic, thromboembolic, or hemorrhagic complications also related to patients presenting dysfunctional coagulation cascade were not encountered. Our experience regarding the replacement technique of silicone cuffed and valved catheters over guidewire was considered feasible, accurate, and efficient for all patients treated, even in those presenting thrombocytopenia or a dysfunctional coagulation cascade.

Clinical outcomes for femoral tunneled-cuffed hemodialysis catheters with different tip positions: A single-center retrospective study.

Tunneled-cuffed catheter (TCC) reaching the mid-atrium has been demonstrated to be associated with improved catheter survival. However, whether similar conclusions can be made for femoral TCC reaching the inferior vena cava (IVC) remains unknown. Data from 47 patients with end-stage renal disease receiving right femoral TCC were retrospectively collected and analyzed. The primary patency, catheter dysfunction, and TCC-associated infection rate were compared between patients with TCC tip at the IVC and those with TCC tip at non-IVC. TCC tips were located at the IVC in 26 patients and non-IVC in 21 patients. The technical success rates for both groups were 100%. The primary patency of the former group were significantly higher than those of the latter group at 3 months (92.3% vs 61.9%, p = 0.011), 6 months (80.8% vs 52.4%, p = 0.017), and 12 months (50.0% vs 28.5%, p = 0.024) follow-up, respectively. Kaplan-Meier curve analysis demonstrated significantly different catheter dysfunction-free survival between the two groups (log-rank p = 0.017). The overall TCC-associated infection rate was similar between the two groups (7.7% vs 9.5%, p = 0.82). Femoral TCC with tips at IVC was associated with higher primary patency, lower catheter dysfunction but similar TCC-associated infection rate as compared with those at non-IVC.

Risk factors for hypotension in patients with hemodialysis-associated superior vena cava syndrome

ObjectiveWe analyzed the risk factors for hypotension in patients with hemodialysis-associated superior vena cava syndrome (SVCS) and effectiveness of endovascular intervention in hypotension related to SVCS. MethodsThis was a retrospective cohort study. A total of 194 maintenance hemodialysis patients diagnosed with SVCS who were admitted to the Department of Nephrology, West China Hospital of Sichuan University from January 2019 to December 2021 were selected and divided into a hypotension group and a nonhypotension group. Demographic and clinical data were compared. Hypotension simply refers to blood pressure levels of <90/60 mm Hg on a nondialysis day. All patients received endovascular intervention. ResultsHypotension was found in 85 of the 194 patients. The following factors were significantly different between the hypotension and nonhypotension groups: body mass index, history of hypertension, tunneled-cuffed catheter as the means of dialysis access, azygos ectasis, SVC stenosis of >70% or occlusion, occlusion at the cavitary junction, serum calcium, diastolic left ventricular (LV) posterior wall thickness, LV end-diastolic volume, stroke output, and LV ejection fraction. Multivariate logistic regression analysis showed that hypertension history (OR, 0.314; P = .027), tunneled-cuffed catheter as vascular access (OR, 3.997; P < .001), SVC stenosis of >70% or occlusion (OR, 5.243; P < .001), LV posterior wall thickness (OR, 0.772; P = .044), and serum calcium (OR, 0.146; P = .005) were independent risk factors for hypotension. The mean values of systolic and diastolic blood pressure after intravascular treatment were significantly elevated from those before intervention (P < .001). The primary patency rates of SVC were 66.8%, 58.7%, and 50.0% at 3, 6, and 12 months after the procedure. ConclusionsThe incidence of hypotension in patients with hemodialysis-associated SVCS is high. The identification of risk factors of hemodialysis-related hypotension provides insight into potential treatment strategies. Endovascular treatment is expected to improve hypotension related to SVCS in hemodialysis patients.

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.

#3438 OUTCOME OF HEMODIALYSIS TUNNELED CUFFED CATHETER PLACEMENT BY THE NEPHROLOGIST AT THE DIALYSIS UNIT

Abstract Background and Aims A large proportion of patients starts dialysis treatment with a temporary catheter which is afterwards replaced by a tunneled cuffed catheter (TCC) by the surgeon or interventional radiologist. This implies a certain dependency on the availability of the surgeon or radiologist. During this waiting time, the patient is exposed to a temporary catheter, which is accompanied by a higher risk of infection. At the UZ Brussel, until 2017 TCC's were placed at the operating room by the surgeon. In September 2017 nephrologists at the UZ Brussel started to place TCC's at the dialysis unit, without the use of fluoroscopy, to lower the time of exposure to a temporary catheter. Method We did a retrospective analysis of 100 patients who got a TCC placed at the dialysis unit from September 2017 until February 2021 (nephrologist group); as a control group we evaluated the last 100 patients who got a TCC by the surgeon before this period. We evaluated complications (during procedure and within the first month), catheter function during the second week and after three months, and waiting time to get a TCC. Logistic regression analysis was performed to detect differences in complication rate and catheter function. Two-way analysis of variance was performed on the log transformed waiting times. Results In both groups, comorbidities such as diabetes mellitus, history of cardiac surgery and presence of a pacemaker or port-a-cath at the time of catheter insertion were comparable. In both groups almost half of the patients were taking antiplatelet therapy. In the nephrologist group more patients got a catheter because of AKI (32% versus 15%) and less patients had a planned admission (19% versus 42%). More patients had a TCC placement after an ICU admission (33% versus 18%) and only few of the catheter placements were replacements of in situ TCC's (3% versus 35%). In the nephrologist group, catheters were inserted in the right (93%) and left jugular vein (7%). In the surgeon group, catheters were inserted in the right (71%) and left jugular vein (23%) and in the subclavian vein (6%). In the nephrologist group there were no failed procedures, but 2 left jugular vein catheters were not in the correct position (turning upwards in the superior vena cava). In 3 patients the carotid artery was punctured and 3 patients had a significant exit site bleeding. In the surgeon group, 3 patients had a failed procedure and 2 patients had a carotid puncture. Analysis of late complications in the nephrologist group showed a bleeding from the exit site in 8 patients, development of bacteremia in 2 patients and the neck wound opened up in 2 patients. In the surgeon group 9 patients had an exit site bleeding, 4 patients had an exit site infection, 2 patients had a bacteremia, 1 patient had a catheter cuff becoming visual at the exit site, 1 patient had a catheter dislocation, 1 patient had a vena cava superior syndrome and 1 patient had a large hematoma. The presence of AKI and the use of antiplatelet therapy were found to be risk factors of getting a late complication. Getting a catheter placed by the nephrologist lowered the risk, even after correction for AKI and antiplatelet therapy, with an odds ratio of 0.414 (p = 0.044). In the nephrologist group, 92% of catheters had a good early function, compared to 84% in the surgeon group. At three months, about half of the catheters were still in use. Catheter function was correct in 87% in the nephrologist group versus 77% in the surgeon group. In patients who first started with a temporary catheter, the mean waiting time to get a TCC in the nephrologist group was 1.6 days compared to 4.5 days in the surgeon group (p &amp;lt; 0.001). In patients who got immediately a TCC the mean waiting time was 0.6 days in the nephrologist group compared to 2.4 days in the surgeon group (p &amp;lt; 0.001). Conclusion In patients who have to start dialysis urgently, TCC's can be placed without fluoroscopy by the nephrologist at the dialysis unit in a safe and efficient manner. This lowers the need for temporary catheters, and shortens the waiting time for getting a TCC.

#6688 HEMODIALYSIS CATHETER-RELATED RIGHT ATRIAL THROMBOSIS AND PULMONARY EMBOLISM: ANTICOAGULANT THERAPY MAY NOT BE REQUIRED

Abstract Background and Aims Though tunneled cuffed catheters (TCCs) are frequently inserted for treating thrombotic malfunction, it is unclear whether such exchanges are associated with an increased risk of pulmonary embolism (PE). This study sought to investigate the incidence of PE among patients with hemodialysis catheter- related right atrial thrombosis (CRAT). Method We conducted a retrospective cohort study on 180 hemodialysis (HD) patients treated in the West China Hospital with a diagnosis of CRAT between May 2018 and March 2020. All cases with CRAT were treated with catheter replacements (guidewire exchange or insertion at new sites) and the tip of new catheters were adjusted to be away from the original position and close to the right atrial. Antiplatelet therapy was started after the surgery with dipyridamole. All patients maintained routine hemodialysis without any thrombolysis or thrombectomy.We investigated the PE incidence and mortality among them. Results Of the 180 patients undergoing catheter replacement and with CART, 10 patients had asymptomatic PEs pre-operation and 3 additional patients developed PE post-operation. During follow-up, two patients died of pneumonia and acute myocardial infarction, respectively, but no patients died due to PE or other thrombosis complications. Conclusion The incidence of PE among HD patients with CRAT is low (5.6%), and there does not appear to exist an elevated risk of fatal PE. Combined catheter.

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.