1
|
Idrees M, Tariq W, Asghar R, Tahir MJ, Mohamed Ahmed KAH, Yousaf Z. Left superior vena cava's unconventional path to left atrium drainage: A case report. Radiol Case Rep 2024; 19:4297-4301. [PMID: 39161565 PMCID: PMC11331709 DOI: 10.1016/j.radcr.2024.06.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 06/23/2024] [Accepted: 06/30/2024] [Indexed: 08/21/2024] Open
Abstract
Persistent left superior vena cava (PLSVC) is a rare congenital anomaly. We presented PLSVC in a patient with end-stage renal disease (ESRD) requiring hemodialysis. The left internal jugular vein was utilized for central venous access due to difficult central vascular access, resulting in a diagnosis of PLSVC draining in the left atrium. This case underscores the importance of awareness of anatomical variations before central catheter placement.
Collapse
Affiliation(s)
| | | | - Rashid Asghar
- Multan Institute of Kidney Diseases, Multan, Pakistan
| | | | | | | |
Collapse
|
2
|
Islam M. Sodium bicarbonate is a potential alternative to classic heparin as a lock solution for non-tunneled dialysis catheters: a result from the prospective randomized BicarbLock trial. Int Urol Nephrol 2024; 56:1465-1474. [PMID: 37823971 DOI: 10.1007/s11255-023-03821-9] [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: 06/21/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE Temporary vascular access is mandatory for acute hemodialysis. Heparin lock solution is the standard of care worldwide. Many lock solutions were studied in terms of thrombosis and catheter-related infection prevention, but none replaced heparin as a standard measure. Our main aim is to investigate the effectiveness of sodium bicarbonate (NaHCO3), a ubiquitous and cheap option as a catheter lock solution, in comparison with traditionally used heparin in non-tunneled hemodialysis catheters. METHODS We conducted our prospective study between March 2021 and March 2022. Our study included 441 patients > 18 years old who needed either femoral or jugular non-tunneled dialysis catheters. Patients were assigned to either heparin (5000 IU/ml) or 8.4% sodium bicarbonate on a consecutive basis. Basic characteristics and information regarding catheters, dialysis sessions, and complications were recorded. We divided patients according to the catheter insertion site as well as the lock solution. RESULTS We analyzed 426 patients divided into four groups: jugular heparin (n = 113), jugular bicarbonate (n = 113), femoral heparin (n = 113), and femoral bicarbonate (n = 100). Basal characteristics were similar for all groups. The mean time to last effective dialysis in our institution was 10.7 ± 12.1 days for heparin vs 11.5 ± 10.8 days for the bicarbonate group. 25 (5.9%) patients had some kind of blood flow problems (13 in the heparin and 12 in the bicarbonate group). There was no significant difference in terms of catheter malfunction among groups (p = 0.50). Out of these 25 cases, only 12 (7 in heparin and 5 in the bicarbonate arm) had catheter dysfunction (p = 0.386). Sixty-four patients (28%) with jugular catheters were discharged with patent catheters and continued their dialysis in other facilities. CONCLUSION Sodium bicarbonate is as effective as classic unfractionated heparin in preventing catheter lumen thrombosis with a comparable incidence of catheter-related complications. Furthermore, it is a cost-effective option that can be used confidently, especially when heparin is contraindicated. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04772209 (26.02.2021).
Collapse
Affiliation(s)
- Mahmud Islam
- Faculty of Medicine, Division of Nephrology, Sakarya University, Adnan Menderes Cad. Sağlık Sok. No. 1, 54100, Adapazarı, Sakarya, Turkey.
| |
Collapse
|
3
|
Bnaya A, Schwartz Y, Wolfovitz Barchad O, Atrash J, Bar-Meir M, Shavit L, Ben-Chetrit E. Clinical presentation and outcome of hemodialysis tunneled catheter-related bloodstream infection in older persons. Eur Geriatr Med 2024; 15:235-242. [PMID: 37713092 DOI: 10.1007/s41999-023-00861-3] [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: 06/13/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The use of a tunneled catheter as the primary vascular access among old hemodialysis patients is frequent. Catheter-related bloodstream infection (CRBSI) is a common complication, associated with increased mortality. Data regarding the clinical presentation and outcomes of CRBSI among old hemodialysis patients is limited. METHODS All chronic hemodialysis patients hospitalized between 2010 and 2022 with CRBSI were included. Patients were classified into two groups: old adults (≥ 75) and younger patients. Clinical, microbiological, and outcome data were collected and analyzed. RESULTS One hundred and fifty-four patients with CRBSI were identified. Fifty-seven were aged ≥ 75 years. Mean age in the older and younger groups was 81.2 ± 5 and 59.7 ± 12.7, respectively. Male gender was predominant (64%). Charlson comorbidity score and Pitt bacteremia score were comparable among both groups. Norton score < 14 was more common among old persons (n = 24, 67% versus n = 21, 31%, p < 0.001), as well as nursing-home residence. Gram-negative pathogens and Staphylococcus aureus were common in both groups. The frequency of inappropriate empirical antimicrobial treatment was higher among older persons. Overall, in-hospital and 90-day mortality was high (age ≥ 75, 36.8%, age < 75, 24.7%, p = 0.14). Age was not significantly associated with mortality after adjustment for low Norton score, residence, and inappropriate antimicrobial therapy as well as resistance patterns of bloodstream isolates [OR = 1.2 (95% CI 0.4-3.3), p = 0.76]. CONCLUSIONS Clinical characteristics and outcomes of CRBSI were comparable among old and young hemodialysis patients. However, the high mortality rate in this cohort suggests that the use of tunneled catheters as a permanent vascular access should be discouraged in both patient groups.
Collapse
Affiliation(s)
- Alon Bnaya
- Institute of Nephrology, Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel
| | - Yuval Schwartz
- Infectious Diseases Unit, Shaare Zedek Medical Center, Affiliated with the Hebrew University, P.O Box 3235, 91031, Jerusalem, Israel
| | - Orit Wolfovitz Barchad
- Infectious Diseases Unit, Shaare Zedek Medical Center, Affiliated with the Hebrew University, P.O Box 3235, 91031, Jerusalem, Israel
| | - Jawad Atrash
- Institute of Nephrology, Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel
| | - Maskit Bar-Meir
- Pediatric Infectious Diseases, Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel
| | - Linda Shavit
- Institute of Nephrology, Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel
| | - Eli Ben-Chetrit
- Infectious Diseases Unit, Shaare Zedek Medical Center, Affiliated with the Hebrew University, P.O Box 3235, 91031, Jerusalem, Israel.
| |
Collapse
|
4
|
van Oevelen M, Heggen BDC, Abrahams AC, Rotmans JI, Snoeijs MGJ, Vernooij RWM, van Buren M, Meijvis SCA. Central venous catheter-related complications in older haemodialysis patients: A multicentre observational cohort study. J Vasc Access 2023; 24:1322-1331. [PMID: 35360988 PMCID: PMC10714686 DOI: 10.1177/11297298221085225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/12/2022] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Central venous catheters (CVC) remain a commonly used vascular access option in haemodialysis, despite guidelines advising to preferably use arteriovenous fistulae. Compared to younger patients, the risk-benefit ratio of CVC in older patients might be more beneficial, but previous studies mainly focussed on catheter-related bacteraemia and/or assessed tunnelled CVC (TCVC) only. This study's aim was to compare all catheter-related infections and malfunctions in older patients with younger patients using all CVC subtypes. MATERIALS AND METHODS We used data from DUCATHO, a multicentre observational cohort study in The Netherlands. All adult patients in whom a CVC was placed for haemodialysis between 2012 and 2016 were included. The primary endpoint was the occurrence of catheter-related infections, comparing patients aged ⩾70 years with patients aged <70 years (reference). As secondary endpoints, catheter malfunctions and catheter removal due to either infection or malfunction were assessed. Using Cox proportional hazards and recurrent events modelling, hazard ratios (HR) with 95% confidence intervals (CI) were calculated with adjustment of prespecified confounders. Additionally, endpoints were assessed for non-tunnelled CVC (NTCVC) and TCVC separately. RESULTS A total of 1595 patients with 2731 CVC (66.5% NTCVC, 33.1% TCVC) were included. Of these patients, 1001 (62.8%) were aged <70 years and 594 (37.2%) ⩾70 years. No statistically significant difference was found for the occurrence of catheter-related infections (adjusted HR 0.80-95% CI 0.62-1.02), catheter malfunction (adjusted HR 0.94-95% CI 0.75-1.17) and catheter removal due to infection or malfunction (adjusted HR 0.94-95% CI 0.80-1.11). Results were comparable when assessing NTCVC and TCVC separately. CONCLUSION Patients aged ⩾70 to <70 years have a comparable risk for the occurrence of catheter-related infections and catheter malfunction. These findings may help when discussing treatment options with older patients starting haemodialysis and may inform the current debate on the best vascular access for these patients.
Collapse
Affiliation(s)
- Mathijs van Oevelen
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Boudewijn DC Heggen
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alferso C Abrahams
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joris I Rotmans
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten GJ Snoeijs
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Robin WM Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marjolijn van Buren
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Department of Nephrology, Haga Hospital, The Hague, The Netherlands
| | - Sabine CA Meijvis
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
5
|
Singh S, Aggarwal HK, Pal S, Chandra H. To assess the impact of training about hospital infection control measures related to hemodialysis services on the knowledge of healthcare providers (HCPs) at the teaching institution of Haryana. J Family Med Prim Care 2023; 12:2738-2744. [PMID: 38186820 PMCID: PMC10771215 DOI: 10.4103/jfmpc.jfmpc_955_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 06/16/2023] [Accepted: 07/17/2023] [Indexed: 01/09/2024] Open
Abstract
Background Adequate knowledge among nursing professionals toward hospital infection control measures related to hemodialysis (HD) services is essential to decrease infection among patients. Objective This study assessed nursing professionals' knowledge about hospital infection control measures related to HD services and the effect of training interventions. Settings and Designs It was a single group, a pre-post-interventional study conducted on nursing professionals of a single apex medical college of Haryana. Materials and Methods A pretested questionnaire consisting of two parts was used as a study tool. Statistical Analysis Various statistical tests such as paired t-test and Pearson's correlation were used. Results The pre-intervention group had a lower mean knowledge score (mean knowledge = 90.2786, strongly disagree [SD] = 15.52682, standard error [SE] = 1.09518) and then the post-intervention mean knowledge score (mean knowledge = 137.5622, SD = 9.72252, SE = 0.68577). Conclusions The training program or educational intervention proved very useful for enhancing nursing professional's knowledge about hospital infection control measures related to HD services.
Collapse
Affiliation(s)
- Sukhbir Singh
- Department of Hospital Administration, Pandit Bhagwat Dayal Sharma, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
- Vice Chancellor, Hemwati Nandan Bahuguna Uttarakhand Medical Education University, Dehradun, Uttarakhand, India
| | - Hari Kishan Aggarwal
- Department of General Medicine, Pandit Bhagwat Dayal Sharma, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Shekhar Pal
- Department of Microbiology, Government Doon Medical College, Dehradun, Uttarakhand, India
| | - Hem Chandra
- Vice Chancellor, Hemwati Nandan Bahuguna Uttarakhand Medical Education University, Dehradun, Uttarakhand, India
| |
Collapse
|
6
|
Cobo-Sánchez JL, Blanco-Mavillard I, Pelayo-Alonso R, Mancebo-Salas N, Fernandez-Fernandez I, De Pedro-Gomez JE. Validity of a catheter exit site clinical assessment scale for the early detection of exit site infections in patients on haemodialysis with a central venous catheter: protocol for a multicentre validation study in Spain (EXITA Study). BMJ Open 2022; 12:e065724. [PMID: 36691132 PMCID: PMC9454082 DOI: 10.1136/bmjopen-2022-065724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/18/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Haemodialysis patients with central venous catheter (HD-CVC) are at increased risk of exit site infections (ESIs) and catheter-related bloodstream infections, causing an increase of hospitalisation, morbidity and mortality rates. The main aim of the EXITA Study is to develop and validate an instrument for the early detection of HD-CVC ESIs. METHODS AND ANALYSIS EXITA is a multicentre prospective cohort study to validate the proposed instrument with a sample of 457 HD-CVCs: 92 in the ESI group and 365 in the non-ESI group. Sample size was calculated using Epidat V.4.2 software, with 95% and 90% expected sensitivity and specificity, respectively, an ESI incidence around 20% and 5%-10% precision range. During each haemodialysis session, the absence or presence of each item will be assessed by nurses. If any item is present, a microbiological study of pericatheter skin smears and/or exit site exudate will be carried out. HD-CVC ESI will be diagnosed when the pericatheter skin smears and/or exit site exudate culture are positive (≥15 CFU/mL by semiquantitative Maki's technique or ≥1000 CFU/mL by Cleri's technique). To validate the scale, a logistic regression analysis will be performed: the β coefficients of each of the signs/symptoms of the scale to be validated will be estimated. We will use logit function and calculate ESI probability=elogit ESI/1+elogit ESI. ETHICS AND DISSEMINATION The study has been approved by the Research Ethics Committee with Medical Products of Cantabria (approval code 2019.146). We will obtain informed consent from all participants before data collection. We will publish the study results in a peer-reviewed scientific journal.
Collapse
Affiliation(s)
- José Luis Cobo-Sánchez
- Nursing Quality, Training, Research, Development and Innovation Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
- Nursing Department, Escuela Universitaría de Enfermería Clínica Mompía-Universidad Católica Santa Teresa de Jesús de Ávila (UCAV), Mompía, Spain
| | - Ian Blanco-Mavillard
- Implementation, Research and Innovation Unit, Hospital de Manacor, Manacor, Spain
- Care, Chronicity and Evidence in Health Research Group (CurES), IdISBa, Palma de Mallorca, Spain
- Nursing and Physiotherapy Department, Balearic Islands University, Palma, Spain
| | - Raquel Pelayo-Alonso
- Nephrology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Noelia Mancebo-Salas
- Department of Nursing, Escuela Universitaria de Enfermería Cruz Roja Española, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Joan Ernest De Pedro-Gomez
- Care, Chronicity and Evidence in Health Research Group (CurES), IdISBa, Palma de Mallorca, Spain
- Nursing and Physiotherapy Department, Balearic Islands University, Palma, Spain
| |
Collapse
|
7
|
Heggen BD, Ramspek CL, van der Bogt KEA, de Haan MW, Hemmelder MH, Hiligsmann MJC, van Loon MM, Rotmans JI, Tordoir JHM, Dekker FW, Schurink GWH, Snoeijs MGJ. Optimising Access Surgery in Senior Haemodialysis Patients (OASIS): study protocol for a multicentre randomised controlled trial. BMJ Open 2022; 12:e053108. [PMID: 35115352 PMCID: PMC8814743 DOI: 10.1136/bmjopen-2021-053108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Current evidence on vascular access strategies for haemodialysis patients is based on observational studies that are at high risk of selection bias. For elderly patients, autologous arteriovenous fistulas that are typically created in usual care may not be the best option because a significant proportion of fistulas either fail to mature or remain unused. In addition, long-term complications associated with arteriovenous grafts and central venous catheters may be less relevant when considering the limited life expectancy of these patients. Therefore, we designed the Optimising Access Surgery in Senior Haemodialysis Patients (OASIS) trial to determine the best strategy for vascular access creation in elderly haemodialysis patients. METHODS AND ANALYSIS OASIS is a multicentre randomised controlled trial with an equal participant allocation in three treatment arms. Patients aged 70 years or older who are expected to initiate haemodialysis treatment in the next 6 months or who have started haemodialysis urgently with a catheter will be enrolled. To detect and exclude patients with an unusually long life expectancy, we will use a previously published mortality prediction model after external validation. Participants allocated to the usual care arm will be treated according to current guidelines on vascular access creation and will undergo fistula creation. Participants allocated to one of the two intervention arms will undergo graft placement or catheter insertion. The primary outcome is the number of access-related interventions required for each patient-year of haemodialysis treatment. We will enrol 195 patients to have sufficient statistical power to detect an absolute decrease of 0.80 interventions per year. ETHICS AND DISSEMINATION Because of clinical equipoise, we believe it is justified to randomly allocate elderly patients to the different vascular access strategies. The study was approved by an accredited medical ethics review committee. The results will be disseminated through peer-reviewed publications and will be implemented in clinical practice guidelines. TRIAL REGISTRATION NUMBER NL7933. PROTOCOL VERSION AND DATE V.5, 25 February 2021.
Collapse
Affiliation(s)
- Boudewijn Dc Heggen
- Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Chava L Ramspek
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Koen E A van der Bogt
- Department of Surgery, Haaglanden Medical Centre, The Hague, Netherlands
- Department of Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Michiel W de Haan
- Department of Radiology, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Marc H Hemmelder
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Mickaël J C Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Magda M van Loon
- Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Joris I Rotmans
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, Netherlands
| | - Jan H M Tordoir
- Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Geert Willem H Schurink
- Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Maarten G J Snoeijs
- Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, Netherlands
| |
Collapse
|
8
|
Catheter-Related Bloodstream Infections and Catheter Colonization among Haemodialysis Patients: Prevalence, Risk Factors, and Outcomes. Int J Nephrol 2021; 2021:5562690. [PMID: 34249377 PMCID: PMC8238579 DOI: 10.1155/2021/5562690] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/13/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction Catheter-related bloodstream infection (CRBSI) and catheter colonization (CC) are two complications among haemodialysis (HD) patients that lead to increased morbidity and mortality. This study aims to evaluate the prevalence of CRBSI and CC among HD patients registered at Universiti Kebangsaan Malaysia Medical Centre and to identify the factors involved by focusing on the demographic profile of the patients as well as their clinical characteristics and outcomes. Method This is a retrospective study of end-stage renal disease patients with suspected CRBSI during the period from 1 January 2016 to 31 December 2018. Data on patients who fulfilled the blood culture criteria for CRBSI and CC diagnosis were further analysed for clinical manifestations, comorbidities, history of dialysis, catheter characteristics, and microbiological culture results. The outcomes of CRBSI and CC were also assessed. Findings. In the 3-year period under study, there were 496 suspected CRBSI cases with a total of 175 events in 119 patients who fulfilled the inclusion criteria. During that time, the percentage of patients who experienced CRBSI and CC was 4.2% and 4.8%, respectively. The majority of the cohort consisted of male (59.4%), Malay ethnicity (75%), and patients on a tunnelled dialysis catheter (83%). Patients who were fistula naïve and had an internal jugular catheter were more common in the CRBSI group than in the CC group. The predominant microorganisms that were isolated were Gram-positive organisms. In terms of clinical presentation and outcome, no differences were found between the CRBSI and CC groups. Patients with Gram-negative bacteraemia, high initial c-reactive protein, and catheter salvation were likely to have poor outcomes. Recurrence of CRBSI occurred in 31% of the cohort. Neither catheter salvation nor antibiotic-lock therapy were associated with the recurrence of CRBSI. On the other hand, the femoral vein catheter site was associated with risk of recurrence. The overall mortality rate was 1.1%. Discussion. From the analysis, it was concluded that clinical assessment and positive culture are crucial in diagnosing CRBSI with or without peripheral culture. This study provides essential information for the local setting which will enable healthcare providers to implement measures for the better management of CRBSI.
Collapse
|
9
|
Locked Away-Prophylaxis and Management of Catheter Related Thrombosis in Hemodialysis. J Clin Med 2021; 10:jcm10112230. [PMID: 34063913 PMCID: PMC8196553 DOI: 10.3390/jcm10112230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/18/2021] [Indexed: 11/17/2022] Open
Abstract
Reliable vascular access is necessary for effective hemodialysis. Guidelines recommend chronic hemodialysis via an arteriovenous fistula (AVF), however, in a significant number of patients, permanent central venous catheters (CVCs) are used. The use of a tunneled catheter is acceptable if the estimated dialysis time is less than a year or it is not possible to create an AVF. The main complications associated with CVC include thrombosis and catheter-related bloodstream infections (CRBSIs), which may result in loss of vascular access. The common practice is to use locking solutions to maintain catheter patency and minimize the risk of CRBSI. This paperwork summarizes information on currently available locking solutions for dialysis catheters along with their effectiveness in preventing thrombotic and infectious complications and describes methods of dealing with catheter dysfunction. The PubMed database was systematically searched for articles about locking solutions used in permanent CVCs in hemodialysis patients. Additional studies were identified by searching bibliographies and international guidelines. Articles on end-stage kidney disease patients dialyzed through a permanent CVC were included. Information from each primary study was extracted using pre-determined criteria including thrombotic and infectious complications of CVC use, focusing on permanent CVC if sufficient data were available. Of the currently available substances, it seems that citrate at a concentration of 4% has the best cost-effectiveness and safety profile, which is reflected in the international guidelines. Recent studies suggest the advantage of 2+1 protocols, i.e., taurolidine-based solutions with addition of urokinase once a week, although it needs to be confirmed by further research. Regardless of the type of locking solution, if prophylaxis with a thrombolytic agent is chosen, it should be started from the very beginning to reduce the risk of thrombotic complications. In case of CVC dysfunction, irrespective of the thrombolysis attempt, catheter replacement should be planned as soon as possible.
Collapse
|
10
|
Porazko T, Stasiak E, Klinger M. The Impact of the Introduction of Innovative REDS Scale for the Evaluation of Central Tunnelled Catheter (CTC) Exit Site on Infection Prevention in Long-Term Haemodialyzed Patients. Front Surg 2021; 8:629367. [PMID: 33898506 PMCID: PMC8062969 DOI: 10.3389/fsurg.2021.629367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
Central tunneled catheter (CTC)-related infections are a leading cause of a catheter loss, thus being the source of significant morbidity and mortality. The study aims at evaluating the impact of the implementation of the innovative redness, edema, discharge and tenderness, symptoms (REDS) scale (devised by the authors) for the description of the tunnel condition on the frequency of infection in long-term catheter users. The same cohort of the 40 patients was observed for 4 years altogether: 2 years before and 2 years after REDS application. The results, as well as follow-up evaluation of participants, were compared. The 2-year cumulative incidence of the CTC exit site infection (ESI) dropped significantly (log-rank p < 0.001) from 0.89 episode/1,000 catheter days (53.5%, 95% CI [35.9%; 66.2%]) in the period before REDS was used—to 0.26 episode/1,000 catheter days (18.6%, 95% CI [6.1%; 29.4%]) in the time of REDS application. There were also significantly fewer episodes of ESI complicated with catheter-related blood stream infection (CRBSI) requiring the CTC removal (0.6 episode/1,000 catheter days; 18.6%, 95% CI [6.1%; 29.4%] vs. 0.3 episode/1,000 catheter days; 4.7%, 95% CI [0.0; 10.7%]; log-rank p = 0.04, in pre-REDS and REDS time, respectively). The REDS scale appears to be a simple, cost-effective tool reducing the frequency of the tunneled CTC exit site infection and associated bloodstream infections.
Collapse
Affiliation(s)
- Tomasz Porazko
- Department of Internal Medicine and Nephrology, Institute of Medical Sciences, University of Opole, Opole, Poland.,Department of Nephrology and Dialysis Unit, University Hospital Opole, Opole, Poland
| | - Edyta Stasiak
- Department of Nephrology and Dialysis Unit, University Hospital Opole, Opole, Poland.,Doctoral School, Silesian Medical University, Katowice, Poland
| | - Marian Klinger
- Department of Internal Medicine and Nephrology, Institute of Medical Sciences, University of Opole, Opole, Poland.,Department of Nephrology and Dialysis Unit, University Hospital Opole, Opole, Poland
| |
Collapse
|
11
|
Heidempergher M, Sabiu G, Orani MA, Tripepi G, Gallieni M. Targeting COVID-19 prevention in hemodialysis facilities is associated with a drastic reduction in central venous catheter-related infections. J Nephrol 2021; 34:345-353. [PMID: 33369726 PMCID: PMC7768271 DOI: 10.1007/s40620-020-00900-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/03/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND In hemodialysis (HD) patients, central venous catheter (CVC) related bloodstream infections are a major cause of morbidity and mortality. Hygienic precautions are a key aspect of dialysis care for infection prevention, but they are not sufficient to completely avoid the occurrence of CVC related infections. During the COVID-19 pandemic, hygienic precautions for preventing viral transmission have been markedly reinforced. We evaluated their effects on CVC-related infection rates. METHODS An observational retrospective study was conducted in two hemodialysis units of the same institution treating 215 chronic hemodialysis patients, 71 of whom are currently (33%) using a CVC. In the CVC cohort, we compared data on catheter-related infection rates during the maximum spread of the COVID-19 pandemic in Italy (February to May 2020) with data from the same period of the previous year and with the whole of 2019. RESULTS In 2019, we recorded a catheter-related bloodstream infection (CRBSI) rate of 1.19 (95% CI 0.81-1.68)/1000 days [2.07 (95% CI 1.12-3.52)/1000 days in the Feb-May 2019 period] and a tunnel and exit-site infection rate of 0.82 (95% CI 0.51-1.24)/1000 days [1.04 (95% CI 0.41-2.15)/1000 days in the Feb-May 2019 period]. Infection rates drastically decreased during the COVID-19 pandemic, with just one catheter-related bloodstream infection being recorded. Catheter-related bloodstream infection rates showed a significant reduction to 0.20 (95% CI 0.01-0.9)/1000 days (p < 0.05 and p < 0.005 compared to 2019 and to Feb-May 2019, respectively) and a non-significant reduction in tunnel and exit-site infections to 0.6 (95% CI 0.15-1.6)/1000 days. CONCLUSIONS The observed 91% reduction in catheter-related bloodstream infections compared to the same period in 2019 [IRR 0.09 (95% CI 0.002-0.64)] and the 83% reduction compared to the whole of 2019 [IRR 0.17 (95% CI 0.004-1.009)] suggest that a stricter implementation of hygienic precautions in the dialysis setting can markedly improve the problem of CVC-related infections.
Collapse
Affiliation(s)
| | - Gianmarco Sabiu
- Nephrology Unit, ASST Fatebenefratelli Sacco, Milano, Italy
- School of Nephrology, Università di Milano, Milano, Italy
| | | | - Giovanni Tripepi
- Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, National Research Council (CNR), Institute of Clinical Physiology (IFC), Reggio Calabria, Italy
| | - Maurizio Gallieni
- Nephrology Unit, ASST Fatebenefratelli Sacco, Milano, Italy.
- School of Nephrology, Università di Milano, Milano, Italy.
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Università di Milano, via G.B. Grassi, 74, 20157, Milano, Italy.
| |
Collapse
|
12
|
Substitution of citrate with tissue plasminogen activator (rt-PA) for catheter lock does not improve patency of tunnelled haemodialysis catheters in a randomised trial. BMC Nephrol 2021; 22:41. [PMID: 33509107 PMCID: PMC7845091 DOI: 10.1186/s12882-021-02243-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/14/2021] [Indexed: 11/10/2022] Open
Abstract
Backround The study aim was to establish if substitution of citrate with rt-PA for catheter lock once weekly can reduce the incidence of catheter-related blood stream infections (CR-BSI) or improve patency of tunneled haemodialysis catheters. Methods All incident patients undergoing insertion of a tunneled haemodialysis catheter were screened and included except those suffering infection or using oral anticoagulation. Study participants were randomized into two arms according to the solution applied as catheter lock: receiving either trisodium citrate (Citra-LockTM 4%) only or rt-PA (Actilyse® 1 mg/ml) on the middle session each week with citrate used on the first and third sessions. The incidence of CR-BSI (confirmed by positive blood culture), catheter non-function (complete obstruction), and malfunction (blood flow < 250 ml/min) was recorded. Statistical significance was tested with ANOVA, post hoc analysis was performed by means of multiple linear regression. Results Totally, 18 patients were included and followed during 655 haemodialysis sessions. No episode of CR-BSI was detected while 6 catheter non-functions (0.9% sessions) and 101 malfunctions (15.4% sessions) were recorded. The incidence of both events was equal between the study arms: 4 non-functions and 55 malfunctions in the rt-PA arm and 2 non-functions and 46 malfunctions in the citrate arm (p = 0.47 and p = 0.24, respectively). Additionally, the mean blood flow achieved did not differ significantly between the arms: 326 ± 1,8 and 326 ± 1,9 ml/min (p = 0.95) in rt-PA and citrate arms, respectively. Post hoc analysis identified time elapsed since previous session (β = 0.12, p = 0.005) and malfunction on previous session (β = 0.25, p < 0.001) as significant factors affecting the occurrence of malfunction. By contrast, the study arm, rt-PA application on previous session, and catheter vintage did not enter the model. Conclusion Substitution of citrate with rt-PA for catheter lock does not reduce the incidence of catheter malfunction neither does it affect the blood flow achieved during haemodialysis. Catheter patency is related rather to the time interval between sessions and to previous malfunction (thus probably reflecting undefined individual factors). The incidence of CR-BSI within pre-selected haemodialysis population is sporadic (less than 1 per 4.3 patient years in our sample). Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12612000152820. Retrospectively registered 03/02/2012.
Collapse
|
13
|
Tavoschi L, Mason L, Petriti U, Bunge E, Veldhuijzen I, Duffell E. Hepatitis B and C among healthcare workers and patient groups at increased risk of iatrogenic transmission in the European Union/European Economic Area. J Hosp Infect 2019; 102:359-368. [PMID: 30885816 PMCID: PMC6667732 DOI: 10.1016/j.jhin.2019.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/11/2019] [Indexed: 02/06/2023]
Abstract
In the European Union/European Economic Area (EU/EEA) approximately 9 million people are chronically infected with hepatitis B virus (HBV) or hepatitis C virus (HCV), and many are undiagnosed. Targeted active case finding initiatives are needed. Iatrogenic transmission of HBV/HCV is relevant in Europe but people at risk of infection are often overlooked. This study aimed to identify groups at increased risk of HBV/HCV infection due to iatrogenic transmission, including healthcare workers, and to estimate incidence and prevalence. PubMed and Embase were systematically searched in February 2017 using strings combining terms for HBV/HCV, occurrence and population subgroups. All retrieved publications were screened and included articles were quality assessed. A predefined set of variables were extracted, and detailed summary tables were developed per population group of interest, virus and outcome. Thirty-eight articles were included, two reported on HBV, 22 on HCV and 16 on both, contributing 70 estimates of prevalence or incidence among: haemodialysis recipients, diabetes patients, recipients of substances of human origin, recipients of medical/dental procedures and healthcare workers. Estimates varied widely from 0.4% to 11.7% for HBV and from 0.7% to over 90% for HCV with most being higher than in the general population. Despite the limited number of studies retrieved, mostly old and focused on populations with multiple risk factors, our findings highlight the importance of considering population groups at higher risk for HBV/HCV iatrogenic transmission as target groups for active case finding in the EU/EEA. Test offers should be guided by individual risk assessment alongside local epidemiological data and local context.
Collapse
Affiliation(s)
- L Tavoschi
- European Centre for Disease Prevention and Control, Stockholm, Sweden; University of Pisa, Pisa, Italy.
| | - L Mason
- Pallas Health Research and Consultancy B.V., Rotterdam, the Netherlands
| | - U Petriti
- Pallas Health Research and Consultancy B.V., Rotterdam, the Netherlands
| | - E Bunge
- Pallas Health Research and Consultancy B.V., Rotterdam, the Netherlands
| | - I Veldhuijzen
- The Netherlands National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - E Duffell
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| |
Collapse
|
14
|
Borisov BK, Linkova SP. Unusual Complication of Hemodialysis Cuffed Catheter Tunnel Infection and Unconventional Therapeutical Decision: A Report of Two Cases. Case Rep Surg 2018; 2018:2405864. [PMID: 30581647 PMCID: PMC6276452 DOI: 10.1155/2018/2405864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/08/2018] [Accepted: 10/31/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Infectious complications are the most common chronic complications observed in patients undergoing hemodialysis with central venous catheters. However, despite the efforts of a large number of medical professionals, tunnel catheters are increasingly being used for hemodialysis in the everyday practice. CASE REPORT We describe two cases of an equal complication of a tunnel infection wherein the catheter becomes naked after self-rupture of the purulent secretion. We did not replace the tunnel catheter but applied a skin plastic by rotation flaps over the affected area, which proved to be sufficient. Six months after the intervention, the patients continue their hemodialysis treatment using the same cuffed catheters; the taken chemocultures do not give rise only to bacterial growth and skin plastic has been healed primary. CONCLUSIONS The two cases described by us represent one treatment option, which may be discussed with reference to such specific two cases in practice.
Collapse
Affiliation(s)
- Biser K. Borisov
- Department of Nephrology and Dialysis, Medical University, Pleven, Bulgaria
| | - Stela P. Linkova
- Department of Nephrology and Dialysis, Medical University, Pleven, Bulgaria
| |
Collapse
|
15
|
van Oevelen M, Abrahams AC, Weijmer MC, Nagtegaal T, Dekker FW, Rotmans JI, Meijvis SC. Precurved non-tunnelled catheters for haemodialysis are comparable in terms of infections and malfunction as compared to tunnelled catheters: A retrospective cohort study. J Vasc Access 2018; 20:307-312. [PMID: 30345873 PMCID: PMC6506901 DOI: 10.1177/1129729818805954] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: The main limitations of central venous catheters for haemodialysis access are
infections and catheter malfunction. Our objective was to assess whether
precurved non-tunnelled central venous catheters are comparable to tunnelled
central venous catheters in terms of infection and catheter malfunction and
to assess whether precurved non-tunnelled catheters are superior to straight
catheters. Materials and methods: In this retrospective, observational cohort study, adult patients in whom a
central venous catheter for haemodialysis was inserted between 2012 and 2016
were included. The primary endpoint was a combined endpoint consisting of
the first occurrence of either an infection or catheter malfunction. The
secondary endpoint was a combined endpoint of the removal of the central
venous catheter due to either an infection or a catheter malfunction. Using
multivariable analysis, cause-specific hazard ratios for endpoints were
calculated for tunnelled catheter versus precurved non-tunnelled catheter,
tunnelled catheter versus non-tunnelled catheter, and precurved versus
straight non-tunnelled catheter. Results: A total of 1603 patients were included. No difference in reaching the primary
endpoint was seen between tunnelled catheters, compared to precurved
non-tunnelled catheters (hazard ratio, 0.91; 95% confidence interval,
0.70–1.19, p = 0.48). Tunnelled catheters were removed less
often, compared to precurved non-tunnelled catheters (hazard ratio, 0.65;
95% confidence interval, 0.46–0.93; p = 0.02). A trend for
less infections and catheter malfunctions was seen in precurved jugular
non-tunnelled catheters compared to straight non-tunnelled catheters (hazard
ratio, 0.60; 95% confidence interval, 0.24–1.50; p = 0.28)
and were removed less often (hazard ratio, 0.41; 95% confidence interval,
0.18–0.93; p = 0.03). Conclusion: Tunnelled central venous catheters and precurved non-tunnelled central venous
catheters showed no difference in reaching the combined endpoint of
catheter-related infections and catheter malfunction. Tunnelled catheters
get removed less often because of infection/malfunction than precurved
non-tunnelled catheters.
Collapse
Affiliation(s)
- Mathijs van Oevelen
- 1 Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alferso C Abrahams
- 1 Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marcel C Weijmer
- 2 Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Tjerko Nagtegaal
- 1 Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Friedo W Dekker
- 3 Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Joris I Rotmans
- 4 Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sabine Ca Meijvis
- 1 Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | | |
Collapse
|
16
|
El Nekidy WS, Soong D, Kadri A, Tabbara O, Ibrahim A, Ghazi IM. Salvage of Hemodialysis Catheter in Staphylococcal Bacteremia: Case Series, Revisiting the Literature, and the Role of the Pharmacist. Case Rep Nephrol Dial 2018; 8:121-129. [PMID: 30140677 PMCID: PMC6103365 DOI: 10.1159/000489923] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/08/2018] [Indexed: 12/12/2022] Open
Abstract
Catheter-related blood stream infections comprise a major concern in hemodialysis patients, leading to increased mortality, morbidity, and cost of treatment. Prompt appropriate systemic antibiotics treatment, which includes administration of appropriate systemic antibiotics and, frequently, catheter removal and replacement, is warranted. However, in hemodialysis patients, repeated catheter insertions may cause central vein stenosis and thrombosis which limits the future availability of hemodialysis access. Lock solutions containing antibiotics and anticoagulants, instilled directly into the catheter lumen after each dialysis, have been successfully utilized for catheter salvage but higher rates of recurrence and complications were observed in infections resulting from staphylococcal species. We report several cases of catheter salvage using antibiotic lock solution in staphylococcal bacteremia with the purpose of stimulating the interest in randomized clinical trials. Evaluating the risk and benefits of catheter salvage in this patient subset in light of optimized systemic antibiotic dosing, improved lock solution use, and multidisciplinary involvement, balanced with the critical need to prevent unnecessary vascular trauma, is of great importance.
Collapse
Affiliation(s)
| | - Derrick Soong
- Department of Pharmacy, Windsor Regional Hospital, Windsor, Ontario, Canada
| | - Albert Kadri
- Department of Nephrology, Windsor Regional Hospital, Windsor, Ontario, Canada
| | - Osama Tabbara
- Department of Pharmacy, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Amina Ibrahim
- Faculty of Biological Sciences, University of Windsor, Windsor, Ontario, Canada
| | - Islam M. Ghazi
- Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, Pennsylvania, USA
| |
Collapse
|
17
|
Suzuki M, Satoh N, Nakamura M, Horita S, Seki G, Moriya K. Bacteremia in hemodialysis patients. World J Nephrol 2016; 5:489-496. [PMID: 27872830 PMCID: PMC5099594 DOI: 10.5527/wjn.v5.i6.489] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/05/2016] [Accepted: 09/21/2016] [Indexed: 02/06/2023] Open
Abstract
Infection is a common complication and is the second leading cause of death in hemodialysis patients. The risk of bacteremia in hemodialysis patients is 26-fold higher than in the general population, and 1/2-3/4 of the causative organisms of bacteremia in hemodialysis patients are Gram-positive bacteria. The ratio of resistant bacteria in hemodialysis patients compared to the general population is unclear. Several reports have indicated that hemodialysis patients have a higher risk of methicillin-resistant Staphylococcus aureus infection. The most common site of infection causing bacteremia is internal prostheses; the use of a hemodialysis catheter is the most important risk factor for bacteremia. Although antibiotic lock of hemodialysis catheters and topical antibiotic ointment can reduce catheter-related blood stream infection (CRBSI), their use should be limited to necessary cases because of the emergence of resistant organisms. Systemic antibiotic administration and catheter removal is recommended for treating CRBSI, although a study indicated the advantages of antibiotic lock and guidewire exchange of catheters over systemic antibiotic therapy. An infection control bundle recommended by the Center for Disease Control and Prevention succeeded in reducing bacteremia in hemodialysis patients with either a catheter or arteriovenous fistula. Appropriate infection control can reduce bacteremia in hemodialysis patients.
Collapse
|
18
|
Murray EC, Deighan C, Geddes C, Thomson PC. Taurolidine-citrate-heparin catheter lock solution reduces staphylococcal bacteraemia rates in haemodialysis patients. QJM 2014; 107:995-1000. [PMID: 24939191 DOI: 10.1093/qjmed/hcu128] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Infection is second only to cardiovascular disease as a cause of death in the haemodialysis (HD) population. AIM : To assess the effect of introducing catheter lock solution taurolidine-citrate-heparin to all tunnelled central venous catheters (TCVCs) on staphylococcal bloodstream infection rates in patients on chronic HD. DESIGN Observational, prospective analysis of the incidence rates of staphylococcal bacteraemic events in National Health Service (NHS) Greater Glasgow & Clyde and NHS Forth Valley between April 2011 and June 2013, with taurolidine-citrate-heparin catheter lock solution introduced July 2012. METHODS Data were collected each calendar quarter through a structured query language interrogation of the renal unit electronic patient record, with staphylococcal bacteraemic events expressed per 1000 vascular access exposed days. Comparison between pre- and post-intervention periods was made by student's t-testing. RESULTS Two hundred and thirty-nine staphylococcal bacteraemic events occurred over a total of 424,835 HD days in 565 patients; 81 events in 289,389 arterio-venous fistula or graft (AVF/AVG) HD days and 158 events in 135 446 TCVC HD days. Following the introduction of taurolidine-citrate-heparin, bacteraemic events in patients dialysing via a TCVC fell from 1.59/1000 HD days to 0.69/1000 HD days, P = 0.004. The staphylococcal bacteraemia rate in AVF/AVGs remained unchanged; 0.30 vs. 0.26/1000 HD days, P = 0.52. CONCLUSIONS Replacing heparin 5000 IU with Taurolidine-citrate-heparin as catheter lock solution was associated with a statistically significant 56% reduction in staphylococcal bloodstream infection rates in our TCVC HD population.
Collapse
Affiliation(s)
- E C Murray
- From the Glasgow Renal and Transplant Unit, Western Infirmary, Glasgow G11 6NT, UK
| | - C Deighan
- From the Glasgow Renal and Transplant Unit, Western Infirmary, Glasgow G11 6NT, UK
| | - C Geddes
- From the Glasgow Renal and Transplant Unit, Western Infirmary, Glasgow G11 6NT, UK
| | - P C Thomson
- From the Glasgow Renal and Transplant Unit, Western Infirmary, Glasgow G11 6NT, UK
| |
Collapse
|
19
|
Brañas P, Morales E, Ríos F, Sanz F, Gutiérrez E, Quintanilla N, Orellana MA, Sánchez M, Rodríguez-Aranda A, Chaves F. Usefulness of endoluminal catheter colonization surveillance cultures to reduce catheter-related bloodstream infections in hemodialysis. Am J Infect Control 2014; 42:1182-7. [PMID: 25248485 DOI: 10.1016/j.ajic.2014.07.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 07/21/2014] [Accepted: 07/21/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND To evaluate the use of surveillance cultures (SCs) to prevent catheter-related bloodstream infections (CRBSIs) in asymptomatic hemodialysis (HD) patients. METHODS In 2011-2012, we conducted a prospective study of HD patients with tunneled cuffed central venous catheters (TCCs). Colonization of the catheter lumen was assessed every 15 days by inoculating ~5 mL endoluminal blood into aerobic culture bottles. Individual patients were triaged based on SC results: group 1 (negative); group 2 (coagulase-negative Staphylococcus [CoNS] with time-to-positivity (TTP) >14 hours); group 3 (CoNS with TTP ≤14 hours); and group 4 (any microorganism other than CoNS and any TTP). RESULTS We studied 104 patients (129 TCCs). Median follow-up was 262.5 days (interquartile range [IR], 135.0-365.0). A total of 1,734 SCs were collected (median, 18 per patient; IR, 10.0-24.0), of which 1,634 (94.2%) were negative (group 1) and 100 (5.8%) were positive (group 2: 79; group 3: 12, group 4: 9). In groups 2 and 3, 19 TCCs required antibiotic lock therapy (ALT). In group 4, all patients received intravenous therapy and ALT. Under this protocol, there were 0.27 episodes of CRBSI per 1,000 catheter days compared with 1.65 (P < .001) prior to its implementation. CONCLUSION SCs based on easily accessible samples proved useful in triaging HD patients at a high risk of infection.
Collapse
|
20
|
Affiliation(s)
- Daniel Landry
- Renal Division, Tufts University School of Medicine, Baystate Medical Center, Springfield, Massachusetts
| | - Gregory Braden
- Renal Division, Tufts University School of Medicine, Baystate Medical Center, Springfield, Massachusetts
| |
Collapse
|
21
|
Abdul Gafor AH, Cheong Ping P, Zainal Abidin AF, Saruddin MZ, Kah Yan N, Adam SQ, Ramli R, Sulong A, Periyasamy P. Antibiogram for haemodialysis catheter-related bloodstream infections. Int J Nephrol 2014; 2014:629459. [PMID: 24587904 PMCID: PMC3920669 DOI: 10.1155/2014/629459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 11/06/2013] [Accepted: 11/18/2013] [Indexed: 11/17/2022] Open
Abstract
Background. Haemodialysis (HD) catheter-related bloodstream infections (CRBSIs) are a major complication of long-term catheter use in HD. This study identified the epidemiology of HD CRBSIs and to aid in the choice of empiric antibiotics therapy given to patients with HD CRBSIs. Methods. Patients with HD CRBSIs were identified. Their blood cultures were performed according to standard sterile technique. Specimens were sent to the microbiology lab for culture and sensitivity testing. Results were tabulated in antibiograms. Results. 18 patients with a median age of 61.0 years (IQR: 51.5-73.25) were confirmed to have HD CRBSIs based on our study criteria. Eight (44.4%) patients had gram-negative infections, 7 (38.9%) patients gram-positive infections, and 3 (16.7%) patients had polymicrobial infections. We noted that most of the gram-negative bacteria were sensitive to ceftazidime. Unfortunately, cloxacillin resistance was high among gram-positive organisms. Coagulase-negative Staphylococcus and Bacillus sp. were the most common gram-positive organisms and they were sensitive to vancomycin. Conclusion. Our study revealed the increased incidence of gram-negative organism in HD CRBSIs. Antibiogram is an important tool in deciding empirical antibiotics for HD CRBSIs. Tailoring your antibiotics accordingly to the antibiogram can increase the chance of successful treatment and prevent the emergence of bacterial resistance.
Collapse
Affiliation(s)
- Abdul Halim Abdul Gafor
- Nephrology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Pau Cheong Ping
- Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Anis Farahanum Zainal Abidin
- Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Muhammad Zulhilmie Saruddin
- Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Ng Kah Yan
- Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Siti Qania'ah Adam
- Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Ramliza Ramli
- Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Anita Sulong
- Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Petrick Periyasamy
- Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
| |
Collapse
|
22
|
Mehrotra R, Glassock RJ, Bleyer AJ. American Society of Nephrology quiz and questionnaire 2012: renal replacement therapy. Clin J Am Soc Nephrol 2013; 8:1632-6. [PMID: 23559678 PMCID: PMC3805063 DOI: 10.2215/cjn.00450113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Presentation of the Nephrology Quiz and Questionnaire has become an annual tradition at the meetings of the American Society of Nephrology. It is a very popular session judged by consistently large attendance. Members of the audience test their knowledge and judgment on a series of case-oriented questions prepared and discussed by experts. They can also compare their answers in real time, using audience response devices, with the answers of program directors of nephrology training programs in the United States acquired through an Internet-based questionnaire. Topics presented here include fluid and electrolyte disorders, glomerular diseases, transplantation, and ESRD and dialysis. Cases representing each of these categories along with single best answer questions were prepared by a panel of experts (Drs. Palmer, Fervenza, and Brennan and Mehrotra, respectively). The correct and incorrect answers then were briefly discussed after the audience responses, and the results of the questionnaire were displayed. This article tries to recapitulate the session and reproduce its educational value for a larger audience-the readers of the CJASN.
Collapse
Affiliation(s)
- Rajnish Mehrotra
- Kidney Research Institute and Harborview Medical Center, Division of Nephrology, University of Washington, Seattle, Washington 98104, USA.
| | | | | |
Collapse
|
23
|
McCann M, Clarke M, Mellotte G, Plant L, Fitzpatrick F. Vascular access and infection prevention and control: a national survey of routine practices in Irish haemodialysis units. Clin Kidney J 2013; 6:176-82. [PMID: 26019846 PMCID: PMC4432454 DOI: 10.1093/ckj/sft020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 02/14/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND National and international guidelines recommend the use of effective vascular access (VA) and infection prevention and control practices within the haemodialysis environment. Establishing an arterio-venous fistula (AVF) and preventing central venous catheter (CVC)-related infections are ongoing challenges for all dialysis settings. We surveyed VA and routine infection prevention and control practices in dialysis units, to provide national data on these practices in Ireland. METHODS A descriptive survey was emailed to nurse managers at all adult (n = 19) and children (n = 1) outpatient haemodialysis units in the Republic of Ireland. Data collected included AVF formation, CVC insertion and maintenance practices, VA use and surveillance of infection and screening protocols. Nineteen of the 20 units responded to the survey. RESULTS The AVF prevalence was 49% for 1370 patients in 17 units who provided these data [mean prevalence per unit: 45.7% (SD 16.2)]; the CVC mean prevalence per unit was 52.5% (SD 16.0). Fourteen dialysis units experienced inadequate access to vascular surgical procedures either due to a lack of dedicated theatre time or hospital beds. Six units administered intravenous prophylactic antimicrobials prior to CVC insertion with only two units using a CVC insertion checklist at the time of catheter insertion. CONCLUSION In general, dialysis units in Ireland show a strong adherence to national guidelines. Compared with the 12 countries participating in the Dialysis Outcomes Practice Patterns Study (DOPPS 4), in 2010, AVF prevalence in Irish dialysis units is the second lowest. Recommendations include establishing an AVF national prevalence target rate, discontinuing the administration of intravenous prophylactic antimicrobials prior to CVC insertion and promoting the use of CVC insertion checklists.
Collapse
Affiliation(s)
- Margaret McCann
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Michael Clarke
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- The All Ireland Hub for Trial Methodology Research, Queens University Belfast, Belfast, UK
| | - George Mellotte
- Department of Nephrology, Tallaght Hospital, Dublin, Ireland
| | - Liam Plant
- HSE National Renal Office andCork University Hospital, Cork, Ireland
| | - Fidelma Fitzpatrick
- Royal College of Physicians in Ireland, Beaumont Hospital & the Health Protection Surveillance Centre, Dublin, Ireland
| |
Collapse
|
24
|
Passerini de Rossi B, Feldman L, Pineda MS, Vay C, Franco M. Comparative in vitro efficacies of ethanol-, EDTA- and levofloxacin-based catheter lock solutions on eradication of Stenotrophomonas maltophilia biofilms. J Med Microbiol 2012; 61:1248-1253. [DOI: 10.1099/jmm.0.039743-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Beatriz Passerini de Rossi
- Cátedra de Microbiología, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Junín 956, 1113 Buenos Aires, Argentina
| | - Laureana Feldman
- Cátedra de Microbiología, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Junín 956, 1113 Buenos Aires, Argentina
| | - María Saliba Pineda
- Cátedra de Microbiología, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Junín 956, 1113 Buenos Aires, Argentina
| | - Carlos Vay
- Laboratorio de Bacteriología Clínica, Departamento de Bioquímica Clínica, Hospital de Clínicas José de San Martín, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Av. Córdoba 2351, 1120 Buenos Aires, Argentina
| | - Mirta Franco
- Cátedra de Microbiología, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Junín 956, 1113 Buenos Aires, Argentina
| |
Collapse
|
25
|
Cepeda CS. Daptomicina en el tratamiento de las infecciones por grampositivos en pacientes con insuficiencia renal crónica. Enferm Infecc Microbiol Clin 2012; 30 Suppl 1:38-42. [DOI: 10.1016/s0213-005x(12)70070-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|
26
|
Campos RP, do Nascimento MM, Chula DC, Riella MC. Minocycline-EDTA lock solution prevents catheter-related bacteremia in hemodialysis. J Am Soc Nephrol 2011; 22:1939-45. [PMID: 21852579 PMCID: PMC3279952 DOI: 10.1681/asn.2010121306] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Accepted: 05/09/2011] [Indexed: 11/03/2022] Open
Abstract
There is growing concern about the development of antibacterial resistance with the use of antibiotics in catheter lock solutions. The use of an antibiotic that is not usually used to treat other serious infections may be an alternative that may reduce the clinical impact should resistance develop. We conducted a randomized controlled trial to compare a solution of minocycline and EDTA with the conventional unfractionated heparin for the prevention of catheter-related bacteremia in hemodialysis patients during a period of 90 d. The study included 204 incident catheters (27.8% tunneled); 14 catheters were excluded because of early dysfunction and 3 because of protocol violations. We observed catheter-related bacteremia in 19 patients in the heparin group (4.3 per 1000 catheter-days) and in 5 patients in the minocycline-EDTA group (1.1 per 1000 catheter-days; P = 0.005). We did not detect a significant difference in the rate of catheter removal for dysfunction. Catheter-related bacteremia-free survival was significantly higher in the minocycline-EDTA group than in the heparin group (P = 0.005). In conclusion, a minocycline-EDTA catheter lock solution is effective in the prevention of catheter-related bacteremia in hemodialysis patients.
Collapse
Affiliation(s)
- Rodrigo Peixoto Campos
- Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba-PR, Brazil.
| | | | | | | |
Collapse
|
27
|
Solomon LR, Cheesbrough JS, Bhargava R, Mitsides N, Heap M, Green G, Diggle P. Observational Study of Need for Thrombolytic Therapy and Incidence of Bacteremia using Taurolidine-Citrate-Heparin, Taurolidine-Citrate and Heparin Catheter Locks in Patients Treated with Hemodialysis. Semin Dial 2011; 25:233-8. [DOI: 10.1111/j.1525-139x.2011.00951.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
28
|
Vanholder R. Reply. Nephrol Dial Transplant 2011. [DOI: 10.1093/ndt/gfr065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
29
|
Lomonte C, Basile C. The role of nephrologist in the management of vascular access. Nephrol Dial Transplant 2011; 26:1461-3. [PMID: 21382990 DOI: 10.1093/ndt/gfr064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
|
30
|
Fluck R, Kumwenda M. Renal Association Clinical Practice Guideline on Vascular Access for Haemodialysis. ACTA ACUST UNITED AC 2011; 118 Suppl 1:c225-40. [DOI: 10.1159/000328071] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 01/05/2011] [Indexed: 12/20/2022]
|
31
|
Rodriguez-Aranda A, Alcazar JM, Sanz F, Garcia-Martin F, Otero JR, Aguado JM, Chaves F. Endoluminal colonization as a risk factor for coagulase-negative staphylococcal catheter-related bloodstream infections in haemodialysis patients. Nephrol Dial Transplant 2010; 26:948-55. [DOI: 10.1093/ndt/gfq481] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
32
|
Vanholder R, Canaud B, Fluck R, Jadoul M, Labriola L, Marti-Monros A, Tordoir J, Van Biesen W. Catheter-related blood stream infections (CRBSI): a European view. Nephrol Dial Transplant 2010; 25:1753-6. [DOI: 10.1093/ndt/gfq205] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|