Catheter-related blood stream infection in hemodialysis patients with symmetric tunneled non-side-hole hemodialysis catheters.

Abstract

BACKGROUND\nTunneled 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.\n\n\nMETHODS\nOver a period of 2\u2009years, a novel symmetric-tip non-side-hole catheter was placed in 60 patients. Hemodialysis was performed thrice weekly. Prescribed dialyzer flows were 300-350\u2009mL/min. Catheters were routinely locked with heparin 5000\u2009units/mL between treatments. Patients were followed up for any catheter related complications, specifically infection events.\n\n\nRESULTS\nSeven events of catheter-related bloodstream infection occurred for a rate of 0.76 events per 1000 catheter-days, with the first event occurring 9\u2009weeks after insertion. These events were treated by locking the affected catheter with 2\u2009g of clindamycin in 2\u2009mL of heparin 1000\u2009units/mL and administration of intravenous antibiotics, in most cases, for 7-14\u2009days. Two catheters were removed due to infection.\n\n\nCONCLUSIONS\nCatheter-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.