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Labriola L, Crott R, Desmet C, Romain C, Jadoul M. Infectious complications associated with buttonhole cannulation of native arteriovenous fistulas: a 22-year follow-up. Nephrol Dial Transplant 2024; 39:1000-1007. [PMID: 37873684 DOI: 10.1093/ndt/gfad229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Buttonhole (BH) cannulation of native arteriovenous fistulas (AVFs) appears to be associated with an increased infectious risk. We previously reported a dramatic increase in the incidence of infectious events (IE) after shift to the BH technique in an in-center hemodialysis unit, which was largely reduced after staff (re)education regarding strict respect of the procedure. We assessed the evolution over the following 12-year period in our center. METHODS In this prospective follow-up of a previous, pre [rope-ladder (RL)]-post (BH) comparison (2001-10), all in-center hemodialysis patients with a native AVF were included from 1 July 2010 to 31 December 2022. Primary and secondary outcomes were IE (unexplained bacteremia due to skin bacteria and/or local AVF infection) and complicated IE (metastatic infection, AVF surgery, death). Overall, the impact of several quality improvement strategies was tested according to the events rate over six periods: Period 1: RL in all; Period 2: switch to BH; Period 3: BH in all, before workshops; Period 4: BH in all, after workshops; Period 5: BH withdrawal in problematic AVFs; Period 6: additional procedural changes. RESULTS This extended observation period allowed the addition of 195 180 AVF-days to our previous report. Overall, 381 661 AVF-days (366 AVFs, 345 patients) were analysed. After an increase of the IE rate in 2012, the shift to RL in problematic AVFs during Period 5 did not have a significant impact. The incidence of IE decrease significantly during Period 6 compared with Periods 3, 4 and 5 {incidence rate ratio (IRR) 0.24 [95% confidence interval (CI) 0.09-0.52], P = .0001, IRR 0.22 (95% CI 0.09-0.47), P < .0001 and IRR 0.29 (95% CI 0.11-0.66), P = .001, respectively}, and became eventually for the first time comparable to Period 1 [IRR 0.59 (95% CI 0.21-1.62), P = .27]. CONCLUSION The constant observance of reinforced hygiene protocols by trained staff and central coordination succeeded in significantly mitigating the infectious risk associated with buttonhole cannulation.
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Affiliation(s)
- Laura Labriola
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
- Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium
| | | | - Christine Desmet
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Cécile Romain
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Michel Jadoul
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
- Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium
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Alfano G, Morisi N, Giovanella S, Frisina M, Amurri A, Tei L, Ferri M, Ligabue G, Donati G. Risk of infections related to endovascular catheters and cardiac implantable devices in hemodialysis patients. J Vasc Access 2024:11297298241240502. [PMID: 38506890 DOI: 10.1177/11297298241240502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
Patients requiring dialysis are extremely vulnerable to infectious diseases. The high burden of comorbidities and weakened immune system due to uremia and previous immunosuppressive therapy expose the patient on dialysis to more infectious events than the general population. The infectious risk is further increased by the presence of endovascular catheters and implantable cardiologic devices. The former is generally placed as urgent vascular access for dialysis and in subjects requiring hemodialysis treatments without autogenous arteriovenous fistula. The high frequency of cardiovascular events also increases the likelihood of implanting indwelling implantable cardiac devices (CIED) such as pacemakers (PMs) and defibrillators (ICDs). The simultaneous presence of CVC and CIED yields an increased risk of developing severe prosthetic device-associated bloodstream infections often progressing to septicemia. Although, antibiotic therapy is the mainstay of prosthetic device-related infections, antibiotic resistance of biofilm-residing bacteria reduces the choice of infection eradication. In these cases, the resolution of the infection process relies on the removal of the prosthetic device. Compared to CVC removal, the extraction of leads is a more complex procedure and poses an increased risk of vessel tearing. As a result, the prevention of prosthetic device-related infection is of utmost importance in hemodialysis (HD) patients and relies principally on avoiding CVC as vascular access for HD and placement of a new class of wireless implantable medical devices. When the combination of CVC and CIED is inevitable, prevention of infection, mainly due translocation of skin bacteria, should be a mandatory priority for healthcare workers.
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Affiliation(s)
- Gaetano Alfano
- Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Emilia-Romagna, Italy
| | - Niccolò Morisi
- Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Emilia-Romagna, Italy
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
| | - Silvia Giovanella
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
| | - Monica Frisina
- Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Emilia-Romagna, Italy
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
| | - Alessio Amurri
- Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Emilia-Romagna, Italy
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
| | - Lorenzo Tei
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
- Nephrology and Dialysis Unit, Azienda USL di Modena, Modena, Emilia-Romagna, Italy
| | - Maria Ferri
- Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Emilia-Romagna, Italy
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
| | - Giulia Ligabue
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
| | - Gabriele Donati
- Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Emilia-Romagna, Italy
- Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
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3
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Mandolfo S, Possenti S, Lucca B, Bracchi M, Bove S, Bertelli C, Costantino E, Alberici F. Tunneled hemodialysis central venous catheters prevalence and bloodstream infection rates in Northern Italy: A survey of the "East Lombardy Nephrological Network". J Vasc Access 2023:11297298231202081. [PMID: 37861341 DOI: 10.1177/11297298231202081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Tunneled central venous catheter (tCVCs) is a vascular access frequently employed in hemodialysis patients. Catheter-related bloodstream infections (CRBSI) are potentially life-threatening complications. METHODS We performed a retrospective survey regarding tCVCs prevalence as well as the CRBSI incidence and management within five hospitals in the Brescia province belonging to the "East Lombardy Nephrological Network"; this study was based upon 18 queries regarding the years 2020 and 2021. RESULTS The data collected refer to an overall hemodialysis population of 736 patients in 2020 and 745 patients in 2021. The prevalence of tCVCs was respectively 22.1% and 24.2% with the initial placement being performed with fluoroscopy support in 80% of the centers. CRBSI incidence was respectively 0.88 and 0.77 episodes per 1000 days of tCVC use. When the CRBI was caused by Staphylococcus Aureus (SA) or Pseudomonas, differently from the recommendation of the KDOQI guidelines, the removal or the substitution of the tCVC did not occur immediately at the time of the diagnosis of the infection but only when the specific antibiotic therapy failed. A nose swab aimed at identifying SA carriers was performed in 60% of centers. The policy regarding the referral to other specialists (infectious disease specialist and microbiologist) was heterogenous across the centers according to their specific logistics. CONCLUSIONS This retrospective survey performed by the "East Lombardy Nephrological Network" within the Brescia province describes the prevalence of tCVCs use as well as the incidence and management of CRBSIs in the hemodialysis patients of this area. The clinical impact of the differences in terms of clinical approach detected compared to the KDOQI guidelines will need to be clarified ideally in prospective studies.
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Affiliation(s)
| | - Stefano Possenti
- Division of Nephrology and Dialysis, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Bernardo Lucca
- Division of Nephrology and Dialysis, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | | | - Sergio Bove
- Emodialisi di Montichiari, ASST Spedali Civili di Brescia, Italy
| | | | | | - Federico Alberici
- Division of Nephrology and Dialysis, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia and ASST Spedali Civili, Brescia, Italy
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Lazarus B, Bongetti E, Ling J, Gallagher M, Kotwal S, Polkinghorne KR. Multifaceted Quality Improvement Interventions to Prevent Hemodialysis Catheter-Related Bloodstream Infections: A Systematic Review. Am J Kidney Dis 2023; 82:429-442.e1. [PMID: 37178814 DOI: 10.1053/j.ajkd.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/06/2023] [Indexed: 05/15/2023]
Abstract
RATIONALE & OBJECTIVE Central venous catheters (CVCs) are widely used for hemodialysis but are prone to burdensome and costly bloodstream infections. We determined whether multifaceted quality improvement interventions in hemodialysis units can prevent hemodialysis catheter-related bloodstream infections (HDCRBSI). STUDY DESIGN Systematic review. SETTING & STUDY POPULATIONS PubMed, EMBASE, and CENTRAL were searched from inception to April 23, 2022, to identify randomized trials, time-series analyses, and before-after studies that examined the effect of multifaceted quality improvement interventions on the incidence of HDCRBSI or access-related bloodstream infections (ARBSI) among people receiving hemodialysis outside of the intensive care unit (ICU). DATA EXTRACTION Two people independently extracted data and assessed the risk of bias and quality of evidence using validated tools. ANALYTICAL APPROACH Intervention effects, validity, and characteristics of studies with the same design were compared. Differences between study designs were described. RESULTS We included 21 studies from 8,824 identified by our search. Among 15 studies that measured HDCRBSI, 2 methodologically heterogenous cluster randomized trials reported discordant intervention effects, 2 interrupted time-series analyses reported favorable interventions with discordant patterns of effect, and 11 before-after studies reported favorable interventions with a very high risk of bias. Among 6 studies that only measured ARBSI, 1 time-series analysis and 1 before-after study did not find a favorable intervention effect, and 4 before-after studies reported a favorable effect with a very high risk of bias. The overall quality of evidence was low for HDCRBSI and very low for ARBSI. LIMITATIONS Nine definitions of HDCRBSI were used. Ten studies included hospital-based and satellite facilities but did not report separate intervention effects for each type of facility. CONCLUSIONS Multifaceted quality improvement interventions may prevent HDCRBSI outside the ICU. However, evidence supporting them is of low quality, and further carefully conducted studies are warranted. REGISTRATION Registered at PROSPERO with registration number CRD42021252290. PLAIN-LANGUAGE SUMMARY People with kidney failure rely on central venous catheters to facilitate life-sustaining hemodialysis treatments. Unfortunately, hemodialysis catheters are a common source of problematic bloodstream infections. Quality improvement programs have effectively prevented catheter-related infections in intensive care units, but it is unclear whether they can be adapted to patients using hemodialysis catheters in the community. In a systematic review that included 21 studies, we found that most quality improvement programs were reported to be successful. However, the findings were mixed among higher-quality studies, and overall the quality of evidence was low. Ongoing quality improvement programs should be complemented by more high-quality research.
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Affiliation(s)
- Benjamin Lazarus
- Department of Medicine, Monash University, Melbourne; Department of Nephrology, Monash Medical Centre, Monash Health, Melbourne; George Institute of Global Health, Sydney.
| | - Elisa Bongetti
- Department of Medicine, Monash University, Melbourne; Department of Nephrology, Monash Medical Centre, Monash Health, Melbourne
| | - Jonathan Ling
- Department of Medicine, Monash University, Melbourne; Department of Nephrology, Monash Medical Centre, Monash Health, Melbourne
| | - Martin Gallagher
- George Institute of Global Health, Sydney; South Western Sydney Campus, University of New South Wales, Sydney
| | - Sradha Kotwal
- George Institute of Global Health, Sydney; Prince of Wales Hospital, University of New South Wales, Sydney, Australia
| | - Kevan R Polkinghorne
- Department of Medicine, Monash University, Melbourne; Department of Nephrology, Monash Medical Centre, Monash Health, Melbourne; School of Public Health and Preventive Medicine, Monash University, Melbourne
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Tal MG, Yevzlin AS. Catheter-related blood stream infection in hemodialysis patients with symmetric tunneled non-side-hole hemodialysis catheters. J Vasc Access 2023; 24:614-619. [PMID: 34289732 PMCID: PMC10566221 DOI: 10.1177/11297298211027058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/02/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Tunneled hemodialysis catheter-related bloodstream infection is a major cause of morbidity and mortality in end-stage renal disease patients. Side holes positioned near the tip of catheters have been linked to formation of thrombi, which, in turn, have been implicated in predisposition to infection. In addition, side holes allow spillage of catheter locking solution, including antibiotics, thereby minimizing the lock solution's effect on the catheter tip. This study assessed the infection events that occurred in a series of hemodialysis patients using a non-side-hole catheter. METHODS Over a period of 2 years, a novel symmetric-tip non-side-hole catheter was placed in 60 patients. Hemodialysis was performed thrice weekly. Prescribed dialyzer flows were 300-350 mL/min. Catheters were routinely locked with heparin 5000 units/mL between treatments. Patients were followed up for any catheter related complications, specifically infection events. RESULTS Seven events of catheter-related bloodstream infection occurred for a rate of 0.76 events per 1000 catheter-days, with the first event occurring 9 weeks after insertion. These events were treated by locking the affected catheter with 2 g of clindamycin in 2 mL of heparin 1000 units/mL and administration of intravenous antibiotics, in most cases, for 7-14 days. Two catheters were removed due to infection. CONCLUSIONS Catheter-related bloodstream infections with non-side-hole hemodialysis catheters do occur at a relatively low rate and in this initial preliminary study it seems that most of these infections can be successfully treated without removal of the affected catheters.
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Affiliation(s)
- Michael G Tal
- Division of Interventional Radiology, Hadassah Medical Center, Jerusalem, Israel
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6
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Cobo-Sánchez JL, Blanco-Mavillard I, Mancebo-Salas N, Moya-Mier S, González-Menéndez F, Renedo-González C, Lázaro-Otero M, Pelayo-Alonso R, Gancedo-González Z, de Pedro-Gómez JE. Early identification of local infections in central venous catheters for hemodialysis: A systematic review. J Infect Public Health 2023; 16:1023-1032. [PMID: 37178476 DOI: 10.1016/j.jiph.2023.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/29/2023] [Accepted: 04/11/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The use of central venous catheters (CVC) is associated with higher morbidity and mortality, related to infectious complications, contributing to poorer clinical outcomes and increased healthcare costs. According to the literature, the incidence of local infections related to CVC for hemodialysis is highly variable. This variability is related to differences in definitions of catheter-related infections. OBJECTIVE To identify signs and symptoms for determining local infections (exit site and tunnel tract infections) used in the literature in tunnelled and nontunnelled CVC for hemodialysis. DESIGN Systematic review METHODS: Structured electronic searches were conducted in five electronic databases, from 1 January 2000-31 August 2022, using key words and specific vocabulary, as well as manual searches in several journals. Additionally, vascular access clinical guidelines and infection control clinical guidelines were reviewed. RESULTS After validity analysis, we selected 40 studies and seven clinical guidelines. The definitions of exit site infection and tunnel infection used in the different studies were heterogeneous. Among the studies, seven (17,5 %) used the definitions of exit site and tunnel infection based on a clinical practice guideline. Three of the studies (7.5 %) used the Twardowski scale definition of exit site infection or a modification. The remaining 30 studies (75 %) used different combinations of signs and symptoms. CONCLUSIONS Definitions of local CVC infections are highly heterogeneous in the revised literature. It is necessary to establish a consensus regarding the definitions of hemodialysis CVC exit site and tunnel infections. REGISTRATION PROSPERO (CRD42022351097).
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Affiliation(s)
- José Luis Cobo-Sánchez
- Hospital Universitario Marqués de Valdecilla - IDIVAL, Santander, Spain; Clínica Mompía School of Nursing, Universidad Católica de Ávila, Mompía, Spain
| | - Ian Blanco-Mavillard
- Department of Nursing and Physiotherapy, Universitat de les Illes Balears, Palma, Spain; Care, Chronicity and Evidence in Health Research Group (CurES), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain; Implementation, Research and Innovation Unit, Hospital de Manacor, Manacor, Spain.
| | - Noelia Mancebo-Salas
- Dirección General de Servicios Sociales. Consejería de Familia, Juventud y Política Social, Comunidad de Madrid, Madrid, Spain
| | - Susana Moya-Mier
- Hospital Universitario Marqués de Valdecilla - IDIVAL, Santander, Spain
| | | | | | - Mercedes Lázaro-Otero
- Hospital Universitario Marqués de Valdecilla - IDIVAL, Santander, Spain; Faculty of Nursing, Universidad de Cantabria, Santander, Spain
| | | | - Zulema Gancedo-González
- Hospital Universitario Marqués de Valdecilla - IDIVAL, Santander, Spain; Escoles Universitaries Gimbernat, Nursing School, Universitat Autonoma Barcelona, Barcelona, Spain
| | - Joan Ernest de Pedro-Gómez
- Department of Nursing and Physiotherapy, Universitat de les Illes Balears, Palma, Spain; Care, Chronicity and Evidence in Health Research Group (CurES), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
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Gimeno-Hernán V, Herrero-Calvo JA, Faraldo-Cabaña A, Zaragoza-García I, Del Pino-Jurado MDR, Ortuño-Soriano I. Análisis de la influencia de la pandemia por el virus SARS-CoV-2 sobre la tasa de bacteriemia en catéteres venosos tunelizados en una unidad de hemodiálisis. ENFERMERÍA NEFROLÓGICA 2023. [DOI: 10.37551/s2254-28842023009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Antecedentes: La infección relacionada con catéter venoso central (CVC) está asociada a una elevada morbimortalidad y se ha relacionado con la bacteriemia asociada a CVC, disfunciones de catéter, la manipulación y las medidas higiénicas tomadas durante la misma.
Objetivo: El objetivo del presente estudio fue comparar la tasa de bacteriemia entre los años 2019 y 2020, primer año de pandemia por el virus SARS-CoV-2, en una unidad de hemodiálisis de un hospital de la Comunidad Autónoma de Madrid.
Material y Método: Se ha llevado a cabo un estudio observacional retrospectivo transversal en el que se compararon datos relativos a la manipulación y al funcionamiento del catéter, y tasa de bacteriemias relacionadas con el catéter entre los años 2019 y 2020 a través de la base de datos de la unidad.
Resultados: En 2019 se incluyeron 35 pacientes, que presentaron una tasa de bacteriemia de 1,42/1000 días de catéter y 29 pacientes en 2020, con una tasa de bacteriemia de 1,82/1000 días de catéter, no encontrándose diferencias significativas (p=0,54), no encontrando un riesgo de bacteriemia incrementado o disminuido durante el primer año de pandemia producida por el virus SARS-CoV-2.
Conclusiones: Como principal conclusión de este estudio, podemos afirmar que no se ha evidenciado que la llegada de la pandemia producida por la enfermedad del coronavirus y las medidas adoptadas frente al virus SARS-CoV-2, tanto organizacionales como de prevención, sean un factor de riesgo o protección respecto a la tasa de bacteriemia, probablemente debido al bajo número de eventos encontrados.
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Gimeno-Hernán V, Herrero-Calvo JA, Faraldo-Cabaña A, Zaragoza-García I, Del Pino-Jurado MR, Ortuño-Soriano I. Análisis de la influencia de la pandemia por el virus SARS-CoV-2 sobre la tasa de bacteriemia en catéteres venosos tunelizados en una unidad de hemodiálisis. ENFERMERÍA NEFROLÓGICA 2023. [DOI: 10.37551/s225428842023009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Antecedentes: La infección relacionada con catéter venoso central (CVC) está asociada a una elevada morbimortalidad y se ha relacionado con la bacteriemia asociada a CVC, disfunciones de catéter, la manipulación y las medidas higiénicas tomadas durante la misma.
Objetivo: El objetivo del presente estudio fue comparar la tasa de bacteriemia entre los años 2019 y 2020, primer año de pandemia por el virus SARS-CoV-2, en una unidad de hemodiálisis de un hospital de la Comunidad Autónoma de Madrid.
Material y Método: Se ha llevado a cabo un estudio observacional retrospectivo transversal en el que se compararon datos relativos a la manipulación y al funcionamiento del catéter, y tasa de bacteriemias relacionadas con el catéter entre los años 2019 y 2020 a través de la base de datos de la unidad.
Resultados: En 2019 se incluyeron 35 pacientes, que presentaron una tasa de bacteriemia de 1,42/1000 días de catéter y 29 pacientes en 2020, con una tasa de bacteriemia de 1,82/1000 días de catéter, no encontrándose diferencias significativas (p=0,54), no encontrando un riesgo de bacteriemia incrementado o disminuido durante el primer año de pandemia producida por el virus SARS-CoV-2.
Conclusiones: Como principal conclusión de este estudio, podemos afirmar que no se ha evidenciado que la llegada de la pandemia producida por la enfermedad del coronavirus y las medidas adoptadas frente al virus SARS-CoV-2, tanto organizacionales como de prevención, sean un factor de riesgo o protección respecto a la tasa de bacteriemia, probablemente debido al bajo número de eventos encontrados.
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Outbreak of central-line-associated bloodstream infections (CLABSIs) amid the coronavirus disease 2019 (COVID-19) pandemic associated with changes in central-line dressing care accompanying changes in nursing education, nursing documentation, and dressing supply kits. Infect Control Hosp Epidemiol 2022; 43:1961-1963. [PMID: 35361306 PMCID: PMC9021583 DOI: 10.1017/ice.2022.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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10
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Neyra NR, Wazir S. The evolving panorama of vascular access in the 21st century. FRONTIERS IN NEPHROLOGY 2022; 2:917265. [PMID: 37675010 PMCID: PMC10479615 DOI: 10.3389/fneph.2022.917265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/31/2022] [Indexed: 09/08/2023]
Abstract
There are three major types of hemodialysis vascular access: hemodialysis catheters, arteriovenous grafts, and arteriovenous fistulas. Arteriovenous fistulas provide the best access due to their reliability and long-term patency. They are recommended by the current Kidney Disease Outcomes Quality Initiatives (K-DOQI) guidelines; however, not all patients benefit from arteriovenous fistulas due to poor maturation or a lack of adequate vasculature. Currently, hemodialysis is initiated via catheters in the majority of patients. Catheters are associated with high morbidity and mortality due to infection, lower quality of dialysis, and the development of central vein stenosis. The varied responses of patients to the different access types exemplify the need to choose the "right access for the right patient" based on scores that can predict death risk and progression of chronic kidney disease. Additionally, vascular access, often referred to as the "Achilles' heel" of hemodialysis patients, represents a significant percentage of the Medicare budget that continues to increase yearly. The purpose of this paper is to review the current literature on the management of vascular access complications and infection treatment and prevention. The paper also explores emerging research regarding the devices and methods to improve access outcomes such as early cannulation arteriovenous grafts, endovascular arteriovenous fistula creation, and regenerative grafts with resorbable scaffolds, among others. The data were collected through literature searches via PubMed, Athens and web search engines.
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Affiliation(s)
- Nilda Roxana Neyra
- Arizona Kidney Disease and Hypertension Center (AKDHC), Phoenix, AZ, United States
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Fadel FI, Sabry S, Mawla MAA, Galal REE, Salah DM, Helmy R, Ramadan Y, Elzayat W, Abdelfattah M, Abd Alazem EA. Covid-19 in Egyptian hemodialysis and kidney transplant children: retrospective analysis of single center experience. Ital J Pediatr 2022; 48:149. [PMID: 35986373 PMCID: PMC9389481 DOI: 10.1186/s13052-022-01345-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Chronic kidney disease stage 5 (CKD 5) populations have peculiar risk for severe Covid-19 infection. Moreover; pediatric data are sparse and lacking. The aim of this study is to report our experience in CKD 5 children treated by hemodialysis (CKD 5D) and CKD 5 children after kidney transplantation (KTR) during one year of Covid-19 pandemic. Methods Retrospective analysis of 57 CKD 5 children with Covid-19 like symptoms during 1 year pandemic was performed. A cohort of 19 confirmed patients (13 CKD 5D and 6 KTR) was analyzed in details as regard clinical, laboratory, radiological criteria, management and their short term outcome. Results Conclusion Pediatric patients on regular HD (CKD 5D) are at higher risk and worse outcome of Covid-19 infection than KT recipients (KTR). Pre-existing HTN and shorter duration after KT are potential risk factors. Reversible AGD after KT and CVC related infections in HD patients are additional presenting features of Covid-19 infection.
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Jimenez MDA, Méndez A, Furaz K, Botella A, Yetman D, Cazar R, Cabana ML, Handel M, Luz sanchez M, Delgado M, Vasquez MM, Martinez MI, Pereira M, González-Parra E, Sánchez MSP, Garayzabal IS, Rodriguez-Osorio L, Portoles J, Hernán D, Miranda B, Arenas MD, Miranda B, Hernán D, Dapena F, Mendez A, Acuña M, Gaitán D, Guerrero E, Furaz K, de la flor JC, Cordón A, Benavides N, González A, Botella A, Naranjo J, Zalamea F, Manso P, Cabana ML, Beato L, Burgos M, Yetman D, Fernández J, Sobrado J, Carneiro D, Caramés C, Handel M, Terleira M, Sánchez ML, Cerón MD, Herruzo J, Barbeito J, Vasquez MM, SanJuan M, Nieto L, Sainz V, Cazar R, Hernández J, Carrillo JG, Martinez MI, Rossignoli A, Hernández RS, Zamora R, Rodriguez-Osorio L, Ledesma C, Pérez AG, Rubio RE, Garayzábal IS, Iglesias A, Pizarro-Sanchez MS, Piña L, Saíco SEP, Tapia MP, Alexandru S, Picasso ML, Gonzalez-Parra E, Pereira M, Feijoo MCF. Impact of the COVID pandemic on vascular access creation for hemodialysis in 16 Spanish hemodialysis centers. Clin Kidney J 2022; 15:1340-1347. [PMID: 35756749 PMCID: PMC9217639 DOI: 10.1093/ckj/sfac094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Indexed: 11/22/2022] Open
Abstract
Background The coronavirus disease (COVID) pandemic has resulted in a major disruption in healthcare that has affected several medical and surgical specialties. European and American Vascular Societies have proposed deferring the creation of an elective vascular access (VA) [autologous or prosthetic arteriovenous fistula (AVF) or arteriovenous graft (AVG)] in incident patients on haemodialysis (HD) in the era of the COVID pandemic. The aim of this study is to examine the impact of the COVID pandemic on VA creation and the central venous catheter (CVC)-related hospitalizations and complications in HD patients dialyzed in 16 Spanish HD units of three different regions. Methods We compared retrospectively two periods of time: the pre-COVID (1 January 2019–11 March 2020) and the COVID era (12 March 2020–30 June 2021) in all HD patients (prevalent and incident) dialyzed in our 16 HD centres. The variables analysed were type of VA (CVC, AVF and AVG) created, percentage of CVC in incident and prevalent HD patients, CVC-related hospitalizations and complications (infection, extrusion, disfunction, catheter removal) and percentage of CVC HD sessions that did not reach the goal of Kt (>45) as a marker of HD adequacy. Results A total of 1791 VAs for HD were created and 905 patients started HD during the study period. Patients who underwent vascular access surgery during the COVID period compared with pre-COVID period were significantly younger, with a significant decrease in surgical activity to create AVFs and AVGs in older HD patients (>75 and >85 years of age). There was a significant increase in CVC placement (from 59.7% to 69.5%; P < 0.001) from the pre-COVID to the COVID period. During the COVID pandemic, a significantly higher number of patients started HD through a CVC (80.3% versus 69.1%; P < 0.001). The percentage of CVC in prevalent HD patients has not decreased in the 19 months since the start of the pandemic [414 CVC/1058 prevalent patients (39.4%)]. No significant changes were detected in CVC-related hospitalizations between the pre-COVID and COVID periods. In the COVID period, a significant increase in catheter replacement and the percentage of HD session that did not reach the HD dose objective (Kt > 45) was observed. Conclusions COVID has presented a public health system crisis that has influenced VA for HD, with an increase in CVCs relative to AVFs. A decrease in HD sessions that did not reach the HD dose objective was observed in the COVID period compared with a pre-COVID period.
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Affiliation(s)
| | - Angel Méndez
- Department of nephrology. Los llanos II center, Getafe, Madrid, Spain
| | - Karina Furaz
- Department of nephrology. Los llanos I center, Móstoles, Madrid, Spain
| | - Ana Botella
- Department of nephrology. Los Lauros center, Majadahonda, Madrid, Spain
| | - Delfina Yetman
- Department of nephrology. Os carballos I center; Vigo, Madrid, Spain
| | - Ramiro Cazar
- Department of nephrology. Santa Engracia center, Madrid, Spain
| | - Mara Lisbet Cabana
- Department of nephrology. Os Carballos II center; Porriño, Madrid, Spain
| | - Marc Handel
- Department of nephrology. El Castañar (Béjar) y las Encinas (Ciudad Rodrigo) centers Salamanca, Spain
| | - María Luz sanchez
- Department of nephrology. El Castañar (Béjar) y las Encinas (Ciudad Rodrigo) centers Salamanca, Spain
| | - Margarita Delgado
- Department of nephrology. Los Pinos center, Medina del campo, Valladolid, Spain
| | | | | | - Monica Pereira
- Department of nephrology. Hospital Fundación Jimenez Diaz, Madrid, Spain
| | | | | | | | | | - José Portoles
- Department of nephrology. Hospital Universitario Puerta de Hierro, Madrid, Spain
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Dahlin L, Taxbro K, Hammarskjöld F. Impact of the COVID-19 pandemic on subcutaneous venous port-related complications in patients with cancer: a retrospective case-control study. World J Surg Oncol 2022; 20:103. [PMID: 35354461 DOI: 10.1186/s12957-022-02568-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vascular access in cancer patients is of great importance in order to deliver tumour-specific therapy and continues to be so during exceptional conditions. This study aimed to examine the impact of the coronavirus disease 2019 pandemic on the care and complication rates associated with subcutaneous venous port (PORT) insertion in cancer treatment. METHODS We retrospectively studied all adult cancer patients that received a PORT in 2020 at a Swedish county hospital, including insertion characteristics and in-dwell complication rates for up to 6 months after implantation; these estimates were compared with historic data. RESULTS Data from 257 patients, of which 56 were haematological patients, were included and compared with those of 168 patients in the control group. The group characteristics were similar, except for the inclusion of haematological patients in the study group. Insertion characteristics showed a shorter waiting time and higher rates of antibiotic and sedative use during the pandemic. The rates of postoperative haematoma and catheter occlusion during the study period were higher than otherwise. The rates of adverse events related to the PORT in the solid tumour group were comparable to those in the control group (18.4% vs. 14.9%). Patients with haematological malignancies were more likely to experience adverse events (37.5% vs. 18.4%) and deep venous thrombosis (7.1% vs. 1.0%) than those with solid tumours. CONCLUSION In conclusion, the present findings suggest that PORTs remain a safe venous access system even during a pandemic, indicating a robust vascular access service.
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Affiliation(s)
- Linnea Dahlin
- Department of Anaesthesia and Intensive Care Medicine, Ryhov County Hospital, Jönköping, Sweden. .,Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
| | - Knut Taxbro
- Department of Anaesthesia and Intensive Care Medicine, Ryhov County Hospital, Jönköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Fredrik Hammarskjöld
- Department of Anaesthesia and Intensive Care Medicine, Ryhov County Hospital, Jönköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Antimicrobial activity of hemodialysis catheter lock solutions in relation to other compounds with antiseptic properties. PLoS One 2021; 16:e0258148. [PMID: 34618850 PMCID: PMC8496847 DOI: 10.1371/journal.pone.0258148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/18/2021] [Indexed: 12/15/2022] Open
Abstract
Proper protection of vascular access after haemodialysis is one of the key measures for the prevention of catheter-related infections. Various substances with bactericidal and anticoagulant properties are used to fill catheters, but due to the unsatisfactory clinical effects and occurrence of adverse reactions, the search for new substances is still ongoing. In the present paper, we compared the in vitro antimicrobial activity of solutions used for tunnelled catheter locking (taurolidine, trisodium citrate) and solutions of substances that could potentially be used for this purpose (sodium bicarbonate, polyhexanide-betaine). The studies have been conducted on bacteria that most commonly cause catheter-related infections. The values of both minimum inhibitory concentration and minimum biofilm eradication concentration of the substances were determined. The ability of the tested substances to eradicate biofilm from the dialysis catheter surface was also evaluated. The results showed that polyhexanide-betaine inhibited the growth of all microbes comparably to taurolidine, even after ≥ 32-fold dilution. The activity of trisodium citrate and sodium bicarbonate was significantly lower. Polyhexanide exhibited the highest activity in the eradication of bacterial biofilm on polystyrene plates. The biofilm formed on a polyurethane dialysis catheter was resistant to complete eradication by the test substances. Polyhexanide-betaine and taurolidine showed the highest activity. Inhibition of bacterial growth regardless of species was observed not only at the highest concentration of these compounds but also after dilution 32–128x (taurolidine) and 32–1024x (polyhexanide-betaine). Therefore, it can be assumed that taurolidine application as a locking solution prevents catheter colonization and systemic infection development. Taurolidine displays high antimicrobial efficacy against Gram-positive cocci as well as Gram-negative bacilli. On the contrary, the lowest antibacterial effect displayed product contained sodium bicarbonate. The inhibitions of bacterial growth were not satisfactory to consider it as a substance for colonization prevention. Polyhexanidine-betaine possessed potent inhibitory and biofilm eradication properties comparing to all tested products. PHMB is applied as a wound irrigation solution worldwide. However, based on our results, we assume that the PHMB is a promising substance for catheter locking solutions thanks to its safety and high antimicrobial properties.
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Analysis of Different Vascular Accesses on Dialysis Quality and Infection Risk Factors of Hemodialysis Patients. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:4554417. [PMID: 34484391 PMCID: PMC8413044 DOI: 10.1155/2021/4554417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/18/2021] [Indexed: 12/05/2022]
Abstract
Objective To explore the influence of different vascular accesses on dialysis quality and infection risk factors of hemodialysis patients. Methods A total of 162 patients with end-stage renal disease admitted to our hospital from February 2018 to July 2020 were divided into two groups: cuff tunnel conduit (CTC) group and native arteriovenous fistula (AVF) group. Peripheral blood was collected before and 6 months after dialysis. The incidence of vascular recirculation was measured, and the risk factors of infection were analyzed. Results The levels of HB, Alb, CRP, BUN, Scr, and TP after dialysis in the two groups were lower than those before dialysis (P < 0.05). The Kt/V of patients in both groups did not exceed 1.2, and the URR value exceeded 60%. The results of independent-samples T test analysis documented that the Kt/V level of patients in the AVF group was higher than that of those in the CTC group after dialysis (P < 0.05). The results of the urea method revealed that 22 of 68 patients (32.35%) in the CVC group and 21 of 94 (22.34%) in the AVF group had vascular pathway recirculation. The χ2 test showed that there was no remarkable difference in the incidence of vascular pathway recirculation between both groups (P > 0.05). However, the results of the nonurea method revealed that the incidence of vascular pathway recirculation in the AVF group was lower than that in the CVC group (P < 0.05). Multivariate logistic regression was used to further analyze the factors with statistical significance in the single factor results. It showed that age >60 years, dialysis duration >1 year, dialysis times, diabetes, hypertension, and CTC were all independent risk factors causing vascular access infection. Conclusion If all conditions permit, AVF hemodialysis is a better choice for patients with end-stage renal disease. For the elderly, long-term hemodialysis, and those with diabetes and hypertension, it is necessary to make detailed plans, strengthen the operation proficiency of CTC, and reduce the incidence of infection.
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Basile C, Lomonte C, Combe C, Covic A, Kirmizis D, Liakopoulos V, Mitra S. A call to optimize haemodialysis vascular access care in healthcare disrupted by COVID-19 pandemic. J Nephrol 2021; 34:365-368. [PMID: 33683675 PMCID: PMC7938289 DOI: 10.1007/s40620-021-01002-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/15/2021] [Indexed: 11/24/2022]
Abstract
The COVID-19 pandemic has resulted in major disruption to the delivery of both routine and urgent healthcare needs in many institutions across the globe. Vascular access (VA) for haemodalysis (HD) is considered the patient's lifeline and its maintenance is essential for the continuation of a life saving treatment. Prior to the COVID-19 pandemic, the provision of VA for dialysis was already constrained. Throughout the pandemic, inevitably, many patients with chronic kidney disease (CKD) have not received timely intervention for VA care. This could have a detrimental impact on dialysis patient outcomes in the near future and needs to be addressed urgently. Many societies have issued prioritisation to allow rationing based on clinical risk, mainly according to estimated urgency and need for treatment. The recommendations recently proposed by the European and American Vascular Societies in the COVID-19 pandemic era regarding the triage of various vascular operations into urgent, emergent and elective are debatable. VA creation and interventions maintain the lifeline of complex HD patients, and the indication for surgery and other interventions warrants patient-specific clinical judgement and pathways. Keeping the use of central venous catheters at a minimum, with the goal of creating the right access, in the right patient, at the right time, and for the right reasons, is mandatory. These strategies may require local modifications. Risk assessments may need specific "renal pathways" to be developed rather than applying standard surgical risk stratification. In conclusion, in order to recover from the second wave of COVID-19 and prepare for further phases, the provision of the best dialysis access, including peritoneal dialysis, will require working closely with the multidisciplinary team involved in the assessment, creation, cannulation, surveillance, maintenance, and salvage of definitive access.
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Affiliation(s)
- Carlo Basile
- Division of Nephrology, Miulli General Hospital, 70021, Acquaviva delle Fonti, Italy. .,Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy.
| | - Carlo Lomonte
- Division of Nephrology, Miulli General Hospital, 70021, Acquaviva delle Fonti, Italy
| | - Christian Combe
- Service de Néphrologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.,Unité INSERM 1026 BioTis, Université de Bordeaux, Bordeaux, France
| | - Adrian Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center - 'C.I. Parhon' University Hospital, and 'Grigore T. Popa' University of Medicine, Iasi, Romania
| | | | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sandip Mitra
- Manchester Academy of Health Sciences Centre, Manchester University Hospitals Foundation Trust and University of Manchester, Oxford Road, Manchester, UK
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Jadoul M, Labriola L. The great help of a virus in the fight against bacteria! J Nephrol 2021; 34:965-966. [PMID: 33683673 PMCID: PMC7938263 DOI: 10.1007/s40620-021-01013-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Michel Jadoul
- Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium.
| | - Laura Labriola
- Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
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