Une stratégie efficace pour diminuer l’utilisation et les complications des cathéters veineux centraux tunnelisés en hémodialyse

[Infectious complications rate from hemodialysis catheters: experience from the French Polynesia]

The arterio-venous fistula (AVF) is the most common vascular access to perform hemodialysis (HD). The HD venous central catheter use should only be proposed to old patients and/or patients without vascular access construction feasibility. These HD catheters are often responsible of infectious and thrombosis complications. We performed, for the first time in French Polynesia, a retrospective study based on 214 patients receiving 618 HD catheters, to evaluate the infectious complication rate due to HD catheters. We showed that 17.4% of HD catheters present with infection. The number of bacteraemia due to HD catheters is 2.57/1000 days-catheters and the number of infection due to HD catheter is 1.43/1000 days-catheters. Eighteen percent of patients requiring an emergency HD without AVF access are transferred in intensive care unit due to infectious HD catheter complications. We observed a similar bacteriological environment than in literature. However, the number of tunneled HD catheter is really lower to that of the number required in European recommendations and we observed an abnormal number of non-functional AVF 1 month after creation. These results involve our nephrology unit to increase the number of tunneled catheters to limit the infectious risk and also to fit with the best practices guidelines.

[Tunnelled internal jugular vein catheters with taurolidine lock: an acceptable challenge to arterio-venous fistula in 70 years old haemodialyzed patients: a prospective pilot study]

Arteriovenous fistula (AVF) is still in 2010 the gold standard of vascular(2) access in haemodialysis (HD) patients. Nevertheless it may be difficult to obtain and/or to use AVF in elderly. With this prospective randomised pilot study, we compare two strategies of vascular access in 70 years old or more new HD patients. AVF were compared to tunnelled jugular vein catheters (TIJC) with taurolidine as bacterial lock solution. Results were as follow: [table: see text] The responses with the visual analogic scale of comfort was 8/10 for TIJC and 5/10 with AVF * P<0.05. In five TIJC patients, heparin was added with success to taurolidine because of partial clotting of catheters. Albuminemia was significantly lower in AVF failure patients compared to AVF success patients (24.8g/L vs 31.1g/L). This pilot study allows to conclude that TIJC is an acceptable challenge to AVF in haemodialysed patients of 70 years or more in a two years long use.

Effectiveness of a protocol for the prevention of hemodialysis venous catheter-related infections

PURPOSE

Infections are a major complication of the use of hemodialysis central venous catheters. In our study we evaluated the efficacy of the hemodialysis central venous catheter protocol management adopted in our center, through a retrospective analysis of all hemodialysis central venous catheters inserted over a period of 6 years.

METHODS

Seventy-three tunneled central venous catheters and 75 temporary central venous catheters were inserted in our center from 2003 to 2008 in 148 patients.

RESULTS

During the follow-up we observed 30 infective events (16 assessed as bacteremias, 14 subcutaneous tunnel or exit site infections) with a rate of 0.65/1,000 days of central venous catheter implantation.

CONCLUSIONS

Our experience confirms, in a 72-month follow-up, the importance of careful central venous catheter management as a crucial feature in reducing the incidence of infective events in patients with central venous catheters in dialytic treatment.