1
|
Srikuea K, Prajumsukh K, Orrapin S, Benyakorn T, Ho P, Rerkasem K, Siribumrungwong B. One-staged brachial-basilic vein transposition versus arm straight arteriovenous graft for hemodialysis. Vascular 2024:17085381241245068. [PMID: 38576306 DOI: 10.1177/17085381241245068] [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: 04/06/2024]
Abstract
OBJECTIVES After forearm and arm cephalic veins are no longer available as options, the choices of arm vascular access between one-staged brachial-basilic vein transposition (BBAVF) and arm straight arteriovenous graft (AS-AVG) for hemodialysis are controversial. This study aims to compare outcomes between groups. METHODS All one-staged BBAVF and AS-AVG from August 2014 to December 2019 were reviewed. In cases of suitable basilic vein of 3 mm or more present from cubital crease to axilla, one-staged BBAVF was preferred. AS-AVG was performed for patients who need timely functioning access or have no suitable basilic vein. RESULTS Twenty-eight one-staged BBAVF and 74 AS-AVG were included. Baseline characteristics were not significantly different, except AS-AVG had less previous ipsilateral access (9% vs 39%; p < .001). Postoperative complications were not different. With six loss follow-ups (3 in BBAVF and 3 in AS-AVG), 24 (96%) and 64 (90%) matured after one-staged BBAVF and AS-AVG, respectively (p = .676). BBAVF took about 30 days (95% CI: 10, 51) longer time to first successful cannulation. Primary patency was significantly better for one-staged BBAVF (hazard ratio (HR) of 3.0 (95%CI: 1.2, 7.7)), whereas secondary patency was not different. The total access failure (i.e. failure to mature combined with any thrombosis or intervention to maintain patency) significantly favored BBAVF (HR 2.7 (95%CI: 1.1, 6.6)). CONCLUSIONS Provided a suitable arm basilic vein is available, one-staged BBAVF is preferred over AS-AVG when forearm AVF, forearm AVG, and arm cephalic veins are out. However, it requires a longer time to start cannulating than AS-AVG.
Collapse
Affiliation(s)
- Kanoklada Srikuea
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine, Thammasat University Hospital, Thammasat University, Pathum Thani, Thailand
| | - Kesanan Prajumsukh
- Department of Surgery, Somdejprasangkharach XVII Hospital, Suphanburi, Thailand
| | - Saritphat Orrapin
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine, Thammasat University Hospital, Thammasat University, Pathum Thani, Thailand
| | - Thoetphum Benyakorn
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine, Thammasat University Hospital, Thammasat University, Pathum Thani, Thailand
| | - Pei Ho
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart System, Singapore
| | - Kittipan Rerkasem
- Environmental - Occupational Health Sciences and Non-Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Boonying Siribumrungwong
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine, Thammasat University Hospital, Thammasat University, Pathum Thani, Thailand
- Center of Excellence in Applied Epidemiology, Faculty of Medicine, Thammasat University Hospital, Thammasat University, Pathum Thani, Thailand
| |
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
|
Chapman C, Meeks B, Ung L, Nichols J. A Case of Myroides odoratimimus Bacteremia due to a Tunneled Dialysis Catheter-Associated Infection in a Paraplegic Patient. Case Rep Infect Dis 2023; 2023:3089837. [PMID: 38020519 PMCID: PMC10657241 DOI: 10.1155/2023/3089837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/30/2023] [Accepted: 11/04/2023] [Indexed: 12/01/2023] Open
Abstract
Myroides odoratimimus is a Gram-negative opportunistic pathogen known to rarely cause a wide range of opportunistic infections in humans. We report a novel case of M. odoratimimus bacteremia in a paraplegic patient with an extensive medical history likely due to a tunneled dialysis catheter infection that was successfully treated with levofloxacin.
Collapse
Affiliation(s)
- Carter Chapman
- Department of Internal Medicine, Infection Disease Division, Texas Tech University Health Sciences Center School of Medicine, 3601 4th St, Lubbock, TX 79430, USA
| | - Barrett Meeks
- Department of Internal Medicine, Infection Disease Division, Texas Tech University Health Sciences Center School of Medicine, 3601 4th St, Lubbock, TX 79430, USA
| | - Liam Ung
- Department of Internal Medicine, Infection Disease Division, Texas Tech University Health Sciences Center School of Medicine, 3601 4th St, Lubbock, TX 79430, USA
| | - Jacob Nichols
- Department of Internal Medicine, Infection Disease Division, Texas Tech University Health Sciences Center School of Medicine, 3601 4th St, Lubbock, TX 79430, USA
| |
Collapse
|
4
|
Alsogair R, Altoub HA, Alsanad M, Alshukr M, AlObaid B, Al Sayyari A, Abdalla M. The Relationship Between C-Reactive Protein (CRP) Concentrations and Erythropoietin Resistance, Hospital Admission Rate, Control of Mineral Metabolism, and Comorbidity in Hemodialysis Patients. Cureus 2023; 15:e48793. [PMID: 38098917 PMCID: PMC10720688 DOI: 10.7759/cureus.48793] [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] [Accepted: 11/14/2023] [Indexed: 12/17/2023] Open
Abstract
Background End-stage kidney disease patients undergoing hemodialysis are prone to develop inflammation detected by high serum C-reactive protein (CRP) levels. This study highlights the association between CRP and the erythropoietin resistance index, hospital admission rate, control of mineral metabolism, and comorbidities in a tertiary hospital and two dialysis centers in Saudi Arabia. Objectives The objective of the study is to assess the relationship between CRP levels and hemoglobin level, hospital admission rate, mineral metabolism, and comorbidity in hemodialysis patients. Materials and methods This was a cross-sectional study conducted at King Abdulaziz Medical City Dialysis Center and the South and North Dialysis Centers of King Abdullah Dialysis Program in Riyadh. All hemodialysis adult patients who have been on dialysis for over six months were included. Patients with acute illnesses and pediatric patients were excluded. The association between CRP and other variables was reported using the Pearson correlation test. The calculated sample size was 218 by using the Raosoft website; however, the final number we analyzed was 209 after exclusion. Results The prevalence of a high level of CRP was more common among patients with diabetes mellitus (p=0.008) and those who were using antihypertensives (p=0.044) while the prevalence of a high level of CRP was less common among underweight patients (p=0.031) and hepatitis C virus (HCV)-positive patients (p=<0.001). The mean value of Kt/V was significantly lower among patients with a high level of CRP (p=0.009). HCV negative was the only independent significant risk factor associated with high CRP concentration (p=0.006). Conclusions In conclusion, there was an association between CRP levels with BMI, diabetics, the use of antihypertensive medications, and negative or undetectable HCV test results with the latter being the only independent significant factor. These data suggest that patients meeting these characteristics are in an inflammatory state and more prone to develop complications; thus, implementing CPR testing in this population might be useful. Other reviews showing causations are needed to further elucidate.
Collapse
Affiliation(s)
- Reema Alsogair
- Medicine and Surgery, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Haifa A Altoub
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Meznah Alsanad
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Malak Alshukr
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Bashayer AlObaid
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Abdulla Al Sayyari
- Rheumatology, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | |
Collapse
|
5
|
Harduin LDO, Barroso TA, Guerra JB, Filippo MG, de Almeida LC, de Castro-Santos G, Oliveira FAC, Cavalcanti DET, Procopio RJ, Lima EC, Pinhati MES, dos Reis JMC, Moreira BD, Galhardo AM, Joviliano EE, de Araujo WJB, de Oliveira JCP. Guidelines on vascular access for hemodialysis from the Brazilian Society of Angiology and Vascular Surgery. J Vasc Bras 2023; 22:e20230052. [PMID: 38021275 PMCID: PMC10648056 DOI: 10.1590/1677-5449.202300522] [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: 03/23/2023] [Accepted: 05/09/2023] [Indexed: 12/01/2023] Open
Abstract
Chronic kidney disease is a worldwide public health problem, and end-stage renal disease requires dialysis. Most patients requiring renal replacement therapy have to undergo hemodialysis. Therefore, vascular access is extremely important for the dialysis population, directly affecting the quality of life and the morbidity and mortality of this patient population. Since making, managing and salvaging of vascular accesses falls within the purview of the vascular surgeon, developing guideline to help specialists better manage vascular accesses for hemodialysis if of great importance. Thus, the objective of this guideline is to present a set of recommendations to guide decisions involved in the referral, evaluation, choice, surveillance and management of complications of vascular accesses for hemodialysis.
Collapse
Affiliation(s)
- Leonardo de Oliveira Harduin
- Universidade Estadual do Estado do Rio de Janeiro - UERJ, Departamento de Cirurgia Vascular, Niterói, RJ, Brasil.
| | | | | | - Marcio Gomes Filippo
- Universidade Federal do Rio de Janeiro - UFRJ, Departamento de Cirurgia, Rio de Janeiro, RJ, Brasil.
| | | | - Guilherme de Castro-Santos
- Universidade Federal de Minas Gerais - UFMG, Escola de Medicina, Departamento de Cirurgia, Belo Horizonte, MG, Brasil.
| | | | | | - Ricardo Jayme Procopio
- Universidade Federal de Minas Gerais - UFMG, Escola de Medicina, Departamento de Cirurgia, Belo Horizonte, MG, Brasil.
| | | | | | | | - Barbara D’Agnoluzzo Moreira
- Universidade Federal do Paraná - UFPR, Hospital de Clínicas, Serviço de Cirurgia Vascular, Curitiba, PR, Brasil.
| | | | - Edwaldo Edner Joviliano
- Universidade de São Paulo - USP, Faculdade de Medicina de Ribeirão Preto - FMRP, Departamento de Anatomia e Cirurgia, Ribeirão Preto, SP, Brasil.
| | - Walter Junior Boim de Araujo
- Universidade Federal do Paraná - UFPR, Hospital de Clínicas, Departamento de Angioradiologia e Cirurgia Endovascular, Curitiba, PR, Brasil.
| | | |
Collapse
|
6
|
Caetano CP, Cassimiro VP, Dionisio DL, Pereira VP, Rodrigues EAC, Rosa PN, Elias DA, Ponce D. Topical gentamicin for the prevention of tunneled hemodialysis catheter-related infections: a randomized double-blind study. J Nephrol 2023; 36:1889-1896. [PMID: 37140818 DOI: 10.1007/s40620-023-01615-x] [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: 10/31/2022] [Accepted: 02/23/2023] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Infection is the second leading cause of death in dialysis patients, with catheter-related bloodstream infection being the most serious. Exit Site Infection and Tunnel Infection are also related to the catheter. OBJECTIVE To compare the infection rates achieved with the application of either topical gentamicin or placebo to the exit-site of tunneled catheters filled with locking solution in chronic hemodialysis patients. METHODS This randomized double-blind clinical trial compared the application of 0.1% gentamicin versus placebo to the exit site of tunneled hemodialysis catheters filled with a prophylactic locking solution. A total of 91 patients were randomly allocated to 2 groups: placebo or 0.1% gentamicin. RESULTS Mean patient age was 60.4 (+ 15.3) years, with predominance of males (60.4%). The main cause of chronic kidney disease was diabetes (40.7%). The rates of exit site infection (placebo = 30% vs. gentamicin = 34.1%, p = 0.821), and bloodstream infection (placebo = 22% vs. gentamicin = 17.1%, p = 0.60), as well as both exit site infection and bloodstream infection incidence density per 1000 catheter-days (p = 1) did not differ between groups. The infection-free curve was also similar in both groups. CONCLUSION The application of topical 0.1% gentamicin to the exit site of tunneled catheters filled with lock solution did not reduce infectious complications when compared to topical placebo in patients on chronic hemodialysis.
Collapse
Affiliation(s)
- Camille Pereira Caetano
- UNESP FMB: Universidade Estadual Paulista Julio de Mesquita Filho Faculdade de Medicina Campus de Botucatu, Botucatu, São Paulo, Brazil.
| | - Vanessa Piacitelli Cassimiro
- UNESP FMB: Universidade Estadual Paulista Julio de Mesquita Filho Faculdade de Medicina Campus de Botucatu, Botucatu, São Paulo, Brazil
| | - Daniele Lopes Dionisio
- UNESP FMB: Universidade Estadual Paulista Julio de Mesquita Filho Faculdade de Medicina Campus de Botucatu, Botucatu, São Paulo, Brazil
| | - Viviane Pollo Pereira
- UNESP FMB: Universidade Estadual Paulista Julio de Mesquita Filho Faculdade de Medicina Campus de Botucatu, Botucatu, São Paulo, Brazil
| | | | - Priscila Nunes Rosa
- UNESP FMB: Universidade Estadual Paulista Julio de Mesquita Filho Faculdade de Medicina Campus de Botucatu, Botucatu, São Paulo, Brazil
| | - Daniele Aparecida Elias
- UNESP FMB: Universidade Estadual Paulista Julio de Mesquita Filho Faculdade de Medicina Campus de Botucatu, Botucatu, São Paulo, Brazil
| | - Daniela Ponce
- UNESP FMB: Universidade Estadual Paulista Julio de Mesquita Filho Faculdade de Medicina Campus de Botucatu, Botucatu, São Paulo, Brazil
| |
Collapse
|
7
|
Saha D, Dighe TA, Sajgure AD, Bale C. Metastatic methicillin-resistant Staphylococcus aureus infection with infective endocarditis, pulmonary septic emboli, axillary abscess with a subacute presentation in a patient with chronic end-stage kidney disease on maintenance haemodialysis. BMJ Case Rep 2023; 16:e254092. [PMID: 37607763 PMCID: PMC10445368 DOI: 10.1136/bcr-2022-254092] [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] [Accepted: 08/14/2023] [Indexed: 08/24/2023] Open
Abstract
A male adult patient on maintenance haemodialysis due to end-stage diabetic nephropathy presented with low-grade intermittent fever, cough and generalised weakness for 3 weeks. Initial blood investigations revealed an elevated neutrophil count with raised inflammatory markers. Chest CT revealed loculated hydropneumothorax with multiple cavitary nodules. Repeated blood cultures from the cuffed tunnelled catheter site and the right arm and sputum cultures were negative for pyogenic bacteria and yeast aetiology. The patient complained about left axillary pain on the fourth day of admission. Ultrasound-guided percutaneous aspiration from an axillary focal collection and subsequent culture revealed a methicillin-resistant Staphylococcus aureus (MRSA) infection. Echocardiography detected multiple vegetations on the tricuspid valve. The patient responded clinically to vancomycin and removal of the permanent catheter. This was a case of a tunnelled catheter-related metastatic MRSA infection with infective endocarditis, pulmonary septic embolism with a subacute presentation, and repeated blood culture negativity.
Collapse
Affiliation(s)
- Debapriya Saha
- Department of Nephrology, Dr. D. Y. Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
| | - Tushar A Dighe
- Department of Nephrology, Dr. D. Y. Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
| | - Atul D Sajgure
- Department of Nephrology, Dr. D. Y. Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
| | - Charan Bale
- Department of Nephrology, Dr. D. Y. Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
| |
Collapse
|
8
|
Celdran-Bonafonte D, Wang LH, Jarrouj A, Campos-Naciff B, Janda J, Roy-Chaudhury P. A pig model of tunneled dialysis catheter (TDC) infection and dysfunction: Opportunities for therapeutic innovation. J Vasc Access 2023; 24:674-682. [PMID: 34553619 DOI: 10.1177/11297298211046751] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although tunneled dialysis catheters (TDC) are far from ideal, they still represent the main form of vascular access for most patients beginning dialysis. Catheters are easy to place and allow patients instant access to dialysis, but regardless of these benefits, catheters are associated with a high incidence of significant complications like bloodstream infections, central venous stenosis, thrombosis, and dysfunction. In the present study, we aim to describe and characterize a swine model of catheter dysfunction and bloodstream infection, that recreates the clinical scenario, to help to serve as a platform to develop therapeutic innovations for this important clinical problem. METHODS Six Yorkshire cross pigs were used in this study. Non-coated commercial catheters were implanted in the external jugular recreating the main features of common clinical practice. Catheters were aseptically accessed twice a week for a mock dialysis procedure (flushing in and out) to assess for and identify catheter dysfunction. Animals were monitored daily for infections; once detected, blood samples were collected for bacterial culture and antibiograms. Study animals were euthanized when nonresponsive to treatment. Tissue samples were collected in a standardized fashion for macroscopic inspection and histological analysis. RESULTS The data analysis revealed an early onset of infection with a median time to infection of 9 days, 40% of the isolates were polymicrobial, and the average time to euthanasia was 20.16 ± 7.3 days. Median time to catheter dysfunction onset was 6 days post-implantation. Postmortem dissection revealed external fibrin sheath and internal thrombosis as the main causes of catheter dysfunction. There was also evidence of central venous stenosis with positive cells for αSMA, CD68, Ki67, Smoothelin, and Vimentin within the venous neointima. CONCLUSIONS The described model represents a reliable and reproducible large animal model of catheter dysfunction and bloodstream infection, which recreates all the main complications of TDC's and so could be used as a validated large animal model to develop new therapies for TDC related infection, thrombosis/dysfunction and central venous stenosis.
Collapse
Affiliation(s)
| | - Lihua H Wang
- Department of Kidney Disease and Blood Purification Centre, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Aous Jarrouj
- Trauma Surgery Division, Charleston Area Medical Center, Charleston, WV, USA
| | - Begona Campos-Naciff
- Division of Nephrology, Department of Internal Medicine, The University of Cincinnati, Cincinnati, OH, USA
| | - Jaroslav Janda
- Department of Pharmacology and Toxicology, College of Pharmacy, The University of Arizona, Tucson, AZ, USA
| | - Prabir Roy-Chaudhury
- UNC Kidney Center, Chapel Hill, NC, USA
- WG (Bill) Hefner VA Medical Center, Salisbury, NC, USA
| |
Collapse
|
9
|
Ellis P. An overview of haemodialysis. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:356-360. [PMID: 37083382 DOI: 10.12968/bjon.2023.32.8.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Affiliation(s)
- Peter Ellis
- Independent nursing and health and social care consultant, educator and writer
| |
Collapse
|
10
|
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.
Collapse
|
11
|
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.
Collapse
|
12
|
Batista JPT, Hamarsha Z, Lew SQ. Endogenous Panophthalmitis and Eye Enucleation Secondary to Methicillin-Resistant Staphylococcus aureus Bacteremia: A Rare Complication of Tunneled Dialysis Catheter Use. Cureus 2023; 15:e35107. [PMID: 36945292 PMCID: PMC10024943 DOI: 10.7759/cureus.35107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 02/19/2023] Open
Abstract
Catheter-related bloodstream infections are among the lethal complications of central venous catheter use. Patients with end-stage kidney disease use tunneled dialysis catheters (TDC) in the absence of arteriovenous access. We report a case of a patient using a TDC who developed panophthalmitis. This patient presented with painful and swollen eyes, fever, and chills. Positive methicillin-resistant Staphylococcus aureus (MRSA) blood cultures were thought to be secondary to a catheter-related bloodstream infection originating from his TDC. A maxillofacial computed tomography scan showed an enlarged, elongated, and proptotic left globe with suspected scleral irregularity suggestive of panophthalmitis. Despite TDC removal and systemic antibiotics, his left eye had to be enucleated. A new TDC was placed after treating the catheter-related bloodstream infection. He continued antibiotic therapy for a total of eight weeks. Panophthalmitis, a rare complication of catheter-related bloodstream infection among hemodialysis patients using a TDC, represents another reason to avoid TDC as hemodialysis access.
Collapse
Affiliation(s)
| | - Zaid Hamarsha
- Critical Care Medicine, Tufts Medical Center, Boston, USA
| | - Susie Q Lew
- Medicine, George Washington University, Washington DC, USA
| |
Collapse
|
13
|
Teh SP, Ho QY, Kee YST, Thangaraju S, Tan RY, Teo SH, Tan HK, Tan CS, Choong HLL, Ng LC, Abdul Rahman M, Lim AEL, Kaushik M. Regional citrate anticoagulation vs systemic heparin anticoagulation for double-filtration plasmapheresis. J Clin Apher 2023; 38:16-23. [PMID: 36197100 DOI: 10.1002/jca.22019] [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: 02/15/2022] [Revised: 08/21/2022] [Accepted: 09/13/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Double-filtration plasmapheresis (DFPP) has been utilized for immunomodulation in kidney transplantation. Anticoagulation is important to maintain circuit patency during DFPP. We aimed to compare the efficacy and safety of regional citrate anticoagulation (RCA) with systemic heparin anticoagulation during DFPP in kidney transplant recipients. METHODS A retrospective cohort study was conducted to compare the efficacy and safety of RCA (RCA-DFPP) to systemic heparin anticoagulation (Hep-DFPP) for DFPP among kidney transplant recipients in a single tertiary center. RESULTS A total of 112 sessions of DFPP were performed for 23 subjects, of which 62 sessions were RCA-DFPP and 50 sessions were Hep-DFPP. There were 13 sessions (11.6%) of premature circuit clotting, 10 sessions (16.1%) for RCA-DFPP and 3 sessions (6.0%) for Hep-DFPP (P = .10). All premature circuit clotting episodes occurred in subjects who underwent DFPP through a vascular catheter. Premature circuit clotting was associated with the use of a vascular catheter (odds ratio [OR] 14.2, 95% confidence interval [CI] 2.7-73.7; P < .01) and high postfilter ionized calcium (OR 12.7, 95% CI 1.4-112.5; P < .01). There was no major bleeding event. Hep-DFPP was associated with higher occurrence of hypocalcemia (OR 1.1, 95% CI 1.0-1.2; P < .01) and metabolic acidosis (OR 1.4, 95% CI 1.2-2.0; P = .04), while hypomagnesemia was more common for RCA-DFPP (OR 2.9, 95% CI 1.1-7.4; P = .03). CONCLUSION Amongst kidney transplant patients who receive DFPP therapy, RCA-DFPP may be comparable to Hep-DFPP for the maintenance of circuit patency. Functioning vascular access is vital in avoiding premature clotting of the circuit. Close monitoring of electrolyte imbalances and coagulopathy related to DFPP is recommended.
Collapse
Affiliation(s)
- Swee Ping Teh
- Department of Renal Medicine, Singapore General Hospital, Singapore, Republic of Singapore.,Department of General Medicine-Renal Medicine, Sengkang General Hospital, Singapore, Republic of Singapore
| | - Quan Yao Ho
- Department of Renal Medicine, Singapore General Hospital, Singapore, Republic of Singapore.,SingHealth Duke-NUS Transplant Centre, Singapore Health Services, Singapore, Republic of Singapore
| | - Yi Shern Terence Kee
- Department of Renal Medicine, Singapore General Hospital, Singapore, Republic of Singapore.,SingHealth Duke-NUS Transplant Centre, Singapore Health Services, Singapore, Republic of Singapore
| | - Sobhana Thangaraju
- Department of Renal Medicine, Singapore General Hospital, Singapore, Republic of Singapore.,SingHealth Duke-NUS Transplant Centre, Singapore Health Services, Singapore, Republic of Singapore
| | - Ru Yu Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore, Republic of Singapore
| | - Su Hooi Teo
- Department of Renal Medicine, Singapore General Hospital, Singapore, Republic of Singapore
| | - Han Khim Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore, Republic of Singapore
| | - Chieh Suai Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore, Republic of Singapore
| | - Hui Lin Lina Choong
- Department of Renal Medicine, Singapore General Hospital, Singapore, Republic of Singapore
| | - Li Choo Ng
- Nursing Division, Singapore General Hospital, Singapore, Republic of Singapore
| | - Maslinna Abdul Rahman
- SingHealth Duke-NUS Transplant Centre, Singapore Health Services, Singapore, Republic of Singapore.,Nursing Division, Singapore General Hospital, Singapore, Republic of Singapore
| | - Amy Ee Lin Lim
- Nursing Division, Singapore General Hospital, Singapore, Republic of Singapore
| | - Manish Kaushik
- Department of Renal Medicine, Singapore General Hospital, Singapore, Republic of Singapore
| |
Collapse
|
14
|
Ghandour M, Thimmisetty RK, Sondheimer J, Imran N, Bhat ZY, Osman-Malik YM. Conversion from Intermittent Hemodialysis to Peritoneal Dialysis in Metastatic Catheter-Related Bloodstream Infection. Case Rep Nephrol Dial 2023; 13:97-103. [PMID: 37900928 PMCID: PMC10601878 DOI: 10.1159/000531094] [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: 09/15/2022] [Accepted: 05/09/2023] [Indexed: 10/31/2023] Open
Abstract
Of all complications from central venous catheters (CVC) in end-stage renal disease (ESRD) patients, catheter-related bloodstream infection (CRBSI) is one of the most devastating consequences. The option of catheter salvage is not an effective measure with metastatic infections. However, in patients with severe vasculopathy and/or near end-stage vascular disease, preservation of the venous access should be given utmost importance as the luxury of utilizing another vascular site is markedly limited. Providing adequate renal replacement therapy in this group of patients can be remarkably challenging for nephrologists. We are presenting an ESRD patient with advanced vascular disease who developed metastatic CRBSI with worsening uremia who was successfully converted from intermittent hemodialysis (IHD) to peritoneal dialysis (PD). Our rationale was to minimize repeated intravascular procedures coupled with the presence of another intravascular device. This has led to a complete resolution of persistent bacteremia, with a steady improvement in the uremic state. Conversion from IHD to PD for persistent bacteremia with metastatic complications was seldom addressed in literature. In the absence of a significant contraindication to PD, it can be considered as a valid alternative possibility in order to interrupt this viscous cycle, especially in vasculopathic patients.
Collapse
Affiliation(s)
- Mohamedanwar Ghandour
- Division of Nephrology and Hypertension, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ravi K Thimmisetty
- Division of Nephrology and Hypertension, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - James Sondheimer
- Division of Nephrology and Hypertension, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Nashat Imran
- Division of Nephrology and Hypertension, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Zeenat Y Bhat
- Division of Nephrology and Hypertension, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Yahya Mohamed Osman-Malik
- Division of Nephrology and Hypertension, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| |
Collapse
|
15
|
Bhat AA, Chandrasekar M, Nambi AP, Bhavani S, Kavitha S, Khan FA. Comparative evaluation of straight and curved extension dialysis catheters for continuous renal replacement therapy in dogs with acute kidney injury. IRANIAN JOURNAL OF VETERINARY RESEARCH 2023; 24:335-338. [PMID: 38799293 PMCID: PMC11127733 DOI: 10.22099/ijvr.2023.47626.6883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 12/01/2023] [Accepted: 12/16/2023] [Indexed: 05/29/2024]
Abstract
Background A patent dual-lumen dialysis catheter is one of the basic requirements for efficient extracorporeal (EC) therapy. Aims The objective of this study was to measure the resistance to blood flow offered by straight and curved-extension dual-lumen dialysis catheters used for continuous renal replacement therapy (CRRT). Methods Twenty dogs suffering from acute kidney injury (AKI) were subjected to CRRT. The dogs were allocated randomly to Group-I (curved extension catheter, n=12) or Group II (straight extension catheter, n=8), based on the type of dual-lumen catheter used in CRRT. The catheter outflow and inflow pressures were recorded at blood pump speeds of 50 ml/min and 99-100 ml/min. Data were tested for normality, and differences in mean inflow and outflow catheter resistances were evaluated for statistical significance using independent samples t-tests. Results Straight extension catheters offered lower inflow resistance than curved extension catheters at both 50 ml/min (41.50 ± 5.84 mm Hg vs. 63.75 ± 6.88 mm Hg, P=0.03) and 99-100 ml/min (63.00 ± 8.11 mm Hg vs. 86.92 ± 7.02 mm Hg, P=0.04) blood flow rates. Straight extension catheters also offered lower outflow resistance than curved catheters at 99-100 ml/min blood flow rate (-94.12 ± 7.91 mm Hg vs. -128.25 ± 7.56 mm Hg, P=0.01; the negative signs only indicate the direction of blood flow). Conclusion These findings suggest that straight-extension dual-lumen dialysis catheters perform better than the curved model in extracorporeal renal replacement therapy by considering their lower resistance to blood flow.
Collapse
Affiliation(s)
- A. A. Bhat
- Department of Veterinary Clinical Medicine, Madras Veterinary College, Tamil Nadu Veterinary and Animal Sciences University, Chennai, India
| | - M. Chandrasekar
- Department of Veterinary Clinical Medicine, Madras Veterinary College, Tamil Nadu Veterinary and Animal Sciences University, Chennai, India
| | - A. P. Nambi
- Department of Veterinary Clinical Medicine, Madras Veterinary College, Tamil Nadu Veterinary and Animal Sciences University, Chennai, India
| | - S. Bhavani
- Department of Veterinary Clinical Medicine, Madras Veterinary College, Tamil Nadu Veterinary and Animal Sciences University, Chennai, India
| | - S. Kavitha
- Department of Veterinary Clinical Medicine, Madras Veterinary College, Tamil Nadu Veterinary and Animal Sciences University, Chennai, India
| | - F. A. Khan
- Department of Large Animal Medicine and Surgery, School of Veterinary Medicine, St. George’s University, True Blue, Grenada
| |
Collapse
|
16
|
Muacevic A, Adler JR. Polyarticular Sepsis Secondary to Staphylococcus aureus Bacteremia Post-acute Hemodialysis: A Case Report. Cureus 2022; 14:e30474. [PMID: 36415439 PMCID: PMC9674046 DOI: 10.7759/cureus.30474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 01/25/2023] Open
Abstract
Polyarticular septic arthritis (PASA) is less common than monoarticular septic arthritis (MASA). There is a low incidence of PASA in immunocompetent patients. This case report describes the development of PASA after hemodialysis through the permcath after a single session.
Collapse
|
17
|
Gautam SC, Lim J, Jaar BG. Complications Associated with Continuous RRT. KIDNEY360 2022; 3:1980-1990. [PMID: 36514412 PMCID: PMC9717642 DOI: 10.34067/kid.0000792022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 09/06/2022] [Indexed: 01/12/2023]
Abstract
Continuous renal replacement therapy (CRRT) is a form of renal replacement therapy that is used in modern intensive care units (ICUs) to help manage acute kidney injury (AKI), end stage kidney disease (ESKD), poisonings, and some electrolyte disorders. CRRT has transformed the care of patients in the ICU over the past several decades. In this setting, it is important to recognize CRRT-associated complications but also up-to-date management of these complications. Some of these complications are minor, but others may be more significant and even life-threatening. Some CRRT complications may be related to dialysis factors and others to specific patient factors. Our overarching goal in this article is to review and discuss the most significant CRRT-related complications at the different stage of management of CRRT. With the advent of newer solutions, there have been newer complications as well.
Collapse
Affiliation(s)
- Samir C. Gautam
- Department of Medicine, Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jonathan Lim
- Department of Medicine, Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, Maryland,Nephrology Center of Maryland, Baltimore, Maryland
| | - Bernard G. Jaar
- Department of Medicine, Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, Maryland,Nephrology Center of Maryland, Baltimore, Maryland,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
18
|
Kotwal S, Cass A, Coggan S, Gray NA, Jan S, McDonald S, Polkinghorne KR, Rogers K, Talaulikar G, Di Tanna GL, Gallagher M. Multifaceted intervention to reduce haemodialysis catheter related bloodstream infections: REDUCCTION stepped wedge, cluster randomised trial. BMJ 2022; 377:e069634. [PMID: 35414532 PMCID: PMC9002320 DOI: 10.1136/bmj-2021-069634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To identify whether multifaceted interventions, or care bundles, reduce catheter related bloodstream infections (CRBSIs) from central venous catheters used for haemodialysis. DESIGN Stepped wedge, cluster randomised design. SETTING 37 renal services across Australia. PARTICIPANTS All adults (age ≥18 years) under the care of a renal service who required insertion of a new haemodialysis catheter. INTERVENTIONS After a baseline observational phase, a service-wide, multifaceted intervention bundle that included elements of catheter care (insertion, maintenance, and removal) was implemented at one of three randomly assigned time points (12 at the first time point, 12 at the second, and 13 at the third) between 20 December 2016 and 31 March 2020. MAIN OUTCOMES MEASURE The primary endpoint was the rate of CRBSI in the baseline phase compared with intervention phase at the renal service level using the intention-to-treat principle. RESULTS 1.14 million haemodialysis catheter days of use were monitored across 6364 patients. Patient characteristics were similar across baseline and intervention phases. 315 CRBSIs occurred (158 in the baseline phase and 157 in the intervention phase), with a rate of 0.21 per 1000 days of catheter use in the baseline phase and 0.29 per 1000 days in the intervention phase, giving an incidence rate ratio of 1.37 (95% confidence interval 0.85 to 2.21; P=0.20). This translates to one in 10 patients who undergo dialysis for a year with a catheter experiencing an episode of CRBSI. CONCLUSIONS Among patients who require a haemodialysis catheter, the implementation of a multifaceted intervention did not reduce the rate of CRBSI. Multifaceted interventions to prevent CRBSI might not be effective in clinical practice settings. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry ACTRN12616000830493.
Collapse
Affiliation(s)
- Sradha Kotwal
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Prince of Wales Hospital, University of New South Wales, Sydney, NSW, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Sarah Coggan
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Nicholas A Gray
- Sunshine Coast University Hospital, Birtinya, QLD, Australia
- Department of Health and Behavioural Science,University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Stephen Jan
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Stephen McDonald
- ANZDATA Registry, South Australia Health and Medical Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Renal Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Kevan R Polkinghorne
- Department of Epidemiology and Preventive Medicine, Monash University, VIC, Australia
- Departments of Nephrology and Medicine, Monash Medical Centre, Monash University, VIC, Australia
| | - Kris Rogers
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Gian Luca Di Tanna
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Martin Gallagher
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, NSW, Sydney, Australia
| |
Collapse
|
19
|
Yeh HT, Liau SK, Niu KY, Hsiao CH, Yeh CC, Lu JX, Ng CJ, Yen CC. Clinical Characteristics and In-Hospital Outcomes in Dialysis Patients with Septic Arthritis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58030401. [PMID: 35334577 PMCID: PMC8953317 DOI: 10.3390/medicina58030401] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/04/2022] [Accepted: 03/06/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Septic arthritis is a medical emergency associated with high morbidity and mortality. The incidence rate of septic arthritis among dialysis patients is higher than the general population, and dialysis patients with bacteremia frequently experience adverse outcomes. The aim of this study was to identify the clinical features and risk factors for longer hospital length of stay (LOS), positive blood culture, and in-hospital mortality in dialysis patients with septic arthritis. Materials and Methods: The medical records of 52 septic arthritis dialysis patients admitted to our hospital from 1 January 2009 to 31 December 2020 were analyzed. The primary outcomes were bacteremia and in-hospital mortality. Variables were compared, and risk factors were evaluated using linear and logistic regression models. Results: Twelve (23.1%) patients had positive blood cultures. A tunneled cuffed catheter for dialysis access was used in eight (15.4%) patients, and its usage rate was significantly higher in patients with positive blood culture than in those with negative blood culture (41.7 vs. 7.5%, p = 0.011). Fever was present in 15 (28.8%) patients, and was significantly more frequent in patients with positive blood culture (58.3 vs. 20%, p = 0.025). The most frequently involved site was the hip (n = 21, 40.4%). The most common causative pathogen was Gram-positive cocci, with MRSA (n = 7, 58.3%) being dominant. The mean LOS was 29.9 ± 25.1 days. The tunneled cuffed catheter was a significant predictor of longer LOS (Coef = 0.49; Cl 0.25−0.74; p < 0.001). The predictors of positive blood culture were fever (OR = 4.91; Cl 1.10−21.83; p = 0.037) and tunneled cuffed catheter (OR = 7.60; Cl 1.31−44.02; p = 0.024). The predictor of mortality was tunneled cuffed catheter (OR = 14.33; Cl 1.12−183.18; p = 0.041). Conclusions: In the dialysis population, patients with tunneled cuffed catheter for dialysis access had a significantly longer hospital LOS. Tunneled cuffed catheter and fever were independent predictors of positive blood culture, and tunneled cuffed catheter was the predictor of in-hospital mortality. The recognition of the associated factors allows for risk stratification and determination of the optimal treatment plan in dialysis patients with septic arthritis.
Collapse
Affiliation(s)
- Hsin-Tzu Yeh
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (H.-T.Y.); (J.-X.L.); (C.-J.N.)
| | - Shuh-Kuan Liau
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan;
| | - Kuang-Yu Niu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung Branch, Keelung 20401, Taiwan; (K.-Y.N.); (C.-C.Y.)
| | - Chien-Han Hsiao
- Department of Linguistics, Indiana University, Bloomington, IN 47405, USA;
| | - Chung-Cheng Yeh
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung Branch, Keelung 20401, Taiwan; (K.-Y.N.); (C.-C.Y.)
| | - Jian-Xun Lu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (H.-T.Y.); (J.-X.L.); (C.-J.N.)
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (H.-T.Y.); (J.-X.L.); (C.-J.N.)
| | - Chieh-Ching Yen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (H.-T.Y.); (J.-X.L.); (C.-J.N.)
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Correspondence: ; Tel.: +886-033281200
| |
Collapse
|
20
|
Lessons for the clinical nephrologist: an uncommon cause of rigors and chills on dialysis. J Nephrol 2022; 35:1505-1507. [PMID: 35112294 DOI: 10.1007/s40620-021-01242-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/26/2021] [Indexed: 10/19/2022]
|
21
|
Hu J, Mei G, Tong C, Gao C, Zhang J. Survival Analysis of Tunneled Cuffed Central Venous Catheters in Maintenance Hemodialysis Patients: A Retrospective Study in China. Int J Clin Pract 2022; 2022:6809670. [PMID: 36187910 PMCID: PMC9509230 DOI: 10.1155/2022/6809670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/30/2022] [Indexed: 11/17/2022] Open
Abstract
AIM The study aimed to investigate the clinical epidemiological data and the survival rate of maintenance hemodialysis patients with tunneled cuffed central venous catheters (TCCs) in a single hemodialysis center in China. METHODS We retrospectively investigated the general clinical characteristics (including sex, age, primary causes, and catheter outcome) of 316 patients undergoing maintenance hemodialysis (MHD) via TCC for >3 months at Wannan Medical College Affiliated Yijishan Hospital, Wuhu, China, from July 2011 to June 2021. The long-term survival rate of the catheters was determined by Kaplan-Meier survival analyses. RESULTS A total of 316 patients (137 males, 179 females) were included, with a mean age of 65.0 ± 15.5 years. The right internal jugular vein was the most commonly used central vein, accounting for 89.1% of catheterizations. After censoring for noncatheter-related events leading to the removal of the catheter, the mean survival time of the TCCs was 26.2 ± 19.8 smonths and the median survival time was 58.0 (95% CI, 54.0-62.0) months. Seventy patients had catheter loss-of-function events, with an incidence of 22.2%. Moreover, 97.3% of TCCs survived 1 year and 43.3% survived 5 years, respectively. The sex and age of the patients were not related to the survival rate (p > 0.05). There were also no statistical differences between the primary diseases of patients and the survival rate of TCCs (p > 0.05). CONCLUSION In this study, we provide evidence of the mean TCC survival time beyond 2 years. We found that TCC is an effective alternative for MHD patients with poor vessel status or limited survival time or become a bridge waiting for arteriovenous fistula to mature, regardless of age, sex, and primary diseases.
Collapse
Affiliation(s)
- Jun Hu
- Hemodialysis Center, Wannan Medical College Affiliated Yijishan Hospital, Wuhu 241000, China
| | - Guangliang Mei
- Outpatient Office, Wannan Medical College Affiliated Yijishan Hospital, Wuhu 241000, China
| | - Changjun Tong
- Hemodialysis Center, Wannan Medical College Affiliated Yijishan Hospital, Wuhu 241000, China
| | - Chaoqing Gao
- Hemodialysis Center, Wannan Medical College Affiliated Yijishan Hospital, Wuhu 241000, China
| | - Jing Zhang
- Department of Nephrology, Wannan Medical College Affiliated Yijishan Hospital, Wuhu 241000, China
| |
Collapse
|
22
|
Tal MG, Yevzlin AS. Initial Clinical Experience with a Symmetric Tip Tunneled Hemodialysis Catheter Without Side Holes. ASAIO J 2021; 67:1257-1262. [PMID: 34534128 PMCID: PMC8555951 DOI: 10.1097/mat.0000000000001552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of this article is to assess the performance and safety of a novel, symmetric, side-hole-free tunneled cuffed catheter hypothesized to sustain adequate flow without the need for side holes. Between November 2016 and January 2019, Pristine hemodialysis catheters were placed de novo in 45 end-stage renal disease patients (27 males and 18 females) at a single investigational site. Forty-one catheters were placed in the right and four in the left internal jugular vein. There were no incidents of insertion failure. Patients had dialysis three times per week and were followed at four investigational sites. Nominal catheter flows, incidence of poor flow, and catheter-related infections were recorded at each dialysis session and analyzed. The average follow-up time was 161.69 days for a total of 7116 catheter days. Nine patients died from reasons unrelated to the catheter and one patient switched to fistula. Four patients had poor flows necessitating catheter replacement. Four patients had catheter-related bloodstream infections which resolved with antibiotics. These equate to 0.56 events per 1000 catheter days. Catheter survival was 100%, 97.6%, and 89.7% at 30, 90, and 180 days, respectively. The initial clinical assessment of the symmetric Pristine hemodialysis catheter featuring a Y-tip devoid of side holes revealed good catheter performance and survival and a low complication rate.
Collapse
Affiliation(s)
- Michael G. Tal
- From the Division of Interventional Radiology, Hadassah Medical Center, Jerusalem, Israel
| | | |
Collapse
|
23
|
Wathanavasin W, Phannajit J, Poosoonthornsri M, Lewsuwan S, Tanateerapong P, Chongthanakorn K, Takkavatakarn K, Katavetin P, Tiranathanagul K, Eiam-Ong S, Susantitaphong P. A Randomized Controlled Trial of Comparative Efficacy between Sodium Bicarbonate and Heparin as A Locking Solution for Tunneled Central Venous Catheters Among Patients Requiring Maintenance Hemodialysis. Can J Kidney Health Dis 2021; 8:20543581211046077. [PMID: 34616559 PMCID: PMC8488503 DOI: 10.1177/20543581211046077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/06/2021] [Indexed: 01/19/2023] Open
Abstract
Background: Sodium bicarbonate (NaHCO3) is one of the promising solutions that has good safety profile and theoretical advantages regarding antimicrobial and antithrombotic properties but there are still limited reports. Objective: To compare the efficacy in lowering rate of catheter loss due to catheter-related thrombosis (CRT) or catheter-related blood stream infection (CRBSI) between sodium bicarbonate and heparin lock in prevalent chronic hemodialysis (HD) patients. Design: A multicenter, randomized, open-label study Setting: In a developing country, Thailand Patients: Chronic HD patients with tunneled central venous catheter Measurements: Catheter loss rate, rate of catheter-related blood stream infection, catheter-related thrombosis, and exit site or tunnel infection Methods: The prospective multicenter randomized controlled trial was conducted, we randomly assigned 118 patients undergoing HD with tunneled central venous catheter to receive a catheter locking solution of sodium bicarbonate or heparin. The primary outcome was a catheter loss rate due to CRT or CRBSI, while the secondary outcome was a composite outcome of CRT, CRBSI, or exit site/tunnel infection (ESI/TI). Results: The present study was stopped early due to an excess of catheter-related thrombosis in the sodium bicarbonate group. From the first 6 weeks of follow-up, there were no catheter losses due to CRT or CRBSI in both groups. The sodium bicarbonate group had a significantly higher rate of the secondary composite outcomes and this was entirely caused by CRT with the median time to thrombosis of 23.6 days. Every CRT event could be successfully rescued by using a single dose of recombinant tissue plasminogen activator (rt-PA). Limitations: Short follow-up period. Conclusions: In prevalent HD patients with tunneled CVCs, use of a sodium bicarbonate locking solution for prevention of CRT is inferior to heparin and is associated with a high rate of catheter-related thrombosis. Trial registration: The study was registered with the Thai Clinical Trials Registry TCTR 20200610003
Collapse
Affiliation(s)
- Wannasit Wathanavasin
- Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.,Nephrology unit, Department of Medicine, Charoenkrung Pracharak Hospital, Bangkok, Thailand
| | - Jeerath Phannajit
- Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.,Research Unit for Metabolic Bone Disease in CKD Patients, Chulalongkorn University, Bangkok, Thailand.,Division of Clinical Epidemiology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | | | - Patchara Tanateerapong
- Nephrology unit, Department of Medicine, Charoenkrung Pracharak Hospital, Bangkok, Thailand
| | | | - Kullaya Takkavatakarn
- Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pisut Katavetin
- Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Khajohn Tiranathanagul
- Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Somchai Eiam-Ong
- Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Paweena Susantitaphong
- Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.,Research Unit for Metabolic Bone Disease in CKD Patients, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
24
|
Neusser MA, Bobe I, Hammermeister A, Wittmann U. A 2% taurolidine catheter lock solution prevents catheter-related bloodstream infection (CRBSI) and catheter dysfunction in hemodialysis patients. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:S24-S32. [PMID: 34288746 DOI: 10.12968/bjon.2021.30.14.s24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
HIGHLIGHTS 2% taurolidine catheter lock solution without additives is safe and efficient. CRBSI and dysfunction rates compare favorably against other studies in hemodialysis. BACKGROUND In hemodialysis patients, catheter-related bloodstream infection (CRBSI) and catheter dysfunction are common and cause significant morbidity, mortality, and costs. Catheter lock solutions reduce CRBSI and catheter dysfunction rates, but solutions containing heparin, citrate, or antibiotics are associated with adverse effects. Due to its antimicrobial and antithrombotic properties and benign safety profile, taurolidine is suitable for use in catheter lock solutions. In this study the effectiveness and safety of a catheter lock solution containing 2% taurolidine without citrate or heparin (TauroSept®, Geistlich Pharma AG, Wolhusen, Switzerland) in hemodialysis patients were investigated for the first time. METHODS Data from 21 patients receiving chronic hemodialysis via tunneled central venous catheters with 2% taurolidine solution as a catheter lock were analyzed in a single-center retrospective study and compared with the existing literature in a review. The primary endpoint was CRBSI rate. Secondary endpoints included catheter dysfunction, treatment, and costs; catheter technical problems, resolution, and costs; and adverse events. Data were compared to outcomes with standard lock solutions in the literature. RESULTS No CRBSIs occurred during the observation period of 5,639 catheter days. The catheter dysfunction rate was 0.71 per 1,000 catheter days, and the catheter dysfunction treatment costs were CHF (Swiss Franc) 543 per patient. No technical problems or adverse events related to the use of 2% taurolidine-containing catheter lock solution were observed. These results compare favorably with other catheter lock solutions. CONCLUSIONS A solution containing 2% taurolidine seems suitable as a hemodialysis catheter lock. In a Swiss cohort, it prevented CRBSI, limited catheter dysfunction, and was cost-efficient.
Collapse
|
25
|
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
|
26
|
Lawson JH, Niklason LE, Roy-Chaudhury P. Challenges and novel therapies for vascular access in haemodialysis. Nat Rev Nephrol 2020; 16:586-602. [PMID: 32839580 PMCID: PMC8108319 DOI: 10.1038/s41581-020-0333-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2020] [Indexed: 02/07/2023]
Abstract
Advances in standards of care have extended the life expectancy of patients with kidney failure. However, options for chronic vascular access for haemodialysis - an essential part of kidney replacement therapy - have remained unchanged for decades. The high morbidity and mortality associated with current vascular access complications highlights an unmet clinical need for novel techniques in vascular access and is driving innovation in vascular access care. The development of devices, biological approaches and novel access techniques has led to new approaches to controlling fistula geometry and manipulating the underlying cellular and molecular pathways of the vascular endothelium, and influencing fistula maturation and formation through the use of external mechanical methods. Innovations in arteriovenous graft materials range from small modifications to the graft lumen to the creation of completely novel bioengineered grafts. Steps have even been taken to create new devices for the treatment of patients with central vein stenosis. However, these emerging therapies face difficult hurdles, and truly creative approaches to vascular access need resources that include well-designed clinical trials, frequent interaction with regulators, interventionalist education and sufficient funding. In addition, the heterogeneity of patients with kidney failure suggests it is unlikely that a 'one-size-fits-all' approach for effective vascular access will be feasible in the current environment.
Collapse
Affiliation(s)
- Jeffrey H Lawson
- Department of Surgery, Duke University, Durham, NC, USA.
- Humacyte, Inc., Durham, NC, USA.
| | - Laura E Niklason
- Humacyte, Inc., Durham, NC, USA
- School of Engineering & Applied Science, Yale University, New Haven, CT, USA
| | - Prabir Roy-Chaudhury
- University of North Carolina Kidney Center, Chapel Hill, NC, USA
- WG (Bill) Hefner VA Medical Center, Salisbury, NC, USA
| |
Collapse
|
27
|
Kotwal S, Coggan S, McDonald S, Talaulikar G, Cass A, Jan S, Polkinghorne KR, Gray NA, Gallagher M. REDUcing the burden of dialysis Catheter ComplicaTIOns: a National approach (REDUCCTION) - design and baseline results. KIDNEY360 2020; 1:746-754. [PMID: 35372959 PMCID: PMC8815740 DOI: 10.34067/kid.0001132020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/29/2020] [Indexed: 04/13/2023]
Abstract
BACKGROUND Patients with hemodialysis central venous catheters (HD CVCs) are susceptible to health care-associated infections, particularly hemodialysis catheter-related bloodstream infection (HD-CRBSI), which is associated with high mortality and health care costs. There have been few systematic attempts to reduce this burden and clinical practice remains highly variable. This manuscript will summarize the challenges in preventing HD-CRBSI and describe the methodology of the REDUcing the burden of dialysis Catheter ComplicaTIOns: a National approach (REDUCCTION) trial. METHODS The REDUCCTION trial is a stepped-wedge cluster randomized trial of a suite of clinical interventions aimed at reducing HD-CRBSI across Australia. It clusters the intervention at the renal-service level with implementation randomly timed across three tranches. The primary outcome is the effect of this intervention upon the rate of HD-CRBSI. Patients who receive an HD CVC at a participating renal service are eligible for inclusion. A customized data collection tool allows near-to-real-time reporting of the number of active catheters, total exposure to catheters over time, and rates of HD-CRBSI in each service. The interventions are centered around the insertion, maintenance, and removal of HD CVC, informed by the most current evidence at the time of design (mid-2018). RESULTS A total of 37 renal services are participating in the trial. Data collection is ongoing with results expected in the last quarter of 2020. The baseline phase of the study has collected provisional data on 5385 catheters in 3615 participants, representing 603,506 days of HD CVC exposure. CONCLUSIONS The REDUCCTION trial systematically measures the use of HD CVCs at a national level in Australia, accurately determines the rate of HD-CRBSI, and tests the effect of a multifaceted, evidence-based intervention upon the rate of HD-CRBSI. These results will have global relevance in nephrology and other specialties commonly using CVCs.
Collapse
Affiliation(s)
- Sradha Kotwal
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Nephrology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Sarah Coggan
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Girish Talaulikar
- Renal Services, ACT Health, Canberra, Australian Capital Territory, Australia
- Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Kevan R. Polkinghorne
- Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia
- Departments of Nephrology and Medicine, Monash Medical Centre, Monash University, Clayton, Victoria, Australia
| | - Nicholas A. Gray
- Sunshine Coast University Hospital, Birtinya, Queensland, Australia
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Martin Gallagher
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
28
|
Infectious Complications of Hemodialysis Tunneled Catheters—Types, Diagnosis, and Treatment Strategies. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02095-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
29
|
Risk factors associated with nosocomial infections among end stage renal disease patients undergoing hemodialysis: A systematic review. PLoS One 2020; 15:e0234376. [PMID: 32569265 PMCID: PMC7307739 DOI: 10.1371/journal.pone.0234376] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 05/26/2020] [Indexed: 02/07/2023] Open
Abstract
Background Profound healthcare challenges confront societies with an increase in prevalence of end-stage renal disease (ESRD), which is one of the leading causes of morbidity and mortality worldwide. Due to several facility and patient related factors, ESRD is significantly associated with increased morbidity and mortality attributed to infections. Aims and objective The aim of this study was to assess systematically the characteristics of patients and risk factors associated with nosocomial infections among ESRD patients undergoing hemodialysis. Methods A systematic literature search was performed to identify eligible studies published during the period from inception to December 2018 pertaining to risk factors associated with nosocomial infections among hemodialysis patients. The relevant studies were generated through a computerized search on five databases (PubMed, EBSCOhost, Google Scholar, ScienceDirect and Scopus) using the Mesh Words: nosocomial infections, hospital acquired infections, healthcare associated infections, end stage renal disease, end stage renal failure, hemodialysis, and risk factors. The complete protocol has been registered under PROSPERO (CRD42019124099). Results Initially, 1411 articles were retrieved. Out of these, 24 were duplicates and hence were removed. Out of 1387 remaining articles, 1337 were removed based on irrelevant titles and/or abstracts. Subsequently, the full texts of 50 articles were reviewed and 41 studies were excluded at this stage due to lack of relevant information. Finally, nine articles were selected for this review. Longer hospital stay, longer duration on hemodialysis, multiple catheter sites, longer catheterization, age group, lower white blood cell count, history of blood transfusion, and diabetes were identified as the major risk factors for nosocomial infections among hemodialysis patients. Conclusion The results of this review indicate an information gap and potential benefits of additional preventive measures to further reduce the risk of infections in hemodialysis population. Moreover, several patient-related and facility-related risk factors were consistently observed in the studies included in this review, which require optimal control measures.
Collapse
|
30
|
Martin K, Lorenzo YSP, Leung PYM, Chung S, O'flaherty E, Barker N, Ierino F. Clinical Outcomes and Risk Factors for Tunneled Hemodialysis Catheter-Related Bloodstream Infections. Open Forum Infect Dis 2020; 7:ofaa117. [PMID: 32550235 PMCID: PMC7291682 DOI: 10.1093/ofid/ofaa117] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/03/2020] [Indexed: 11/13/2022] Open
Abstract
Diabetes and left internal jugular vein insertion site were significantly associated with increased risk of a catheter-related bloodstream infection from a tunneled hemodialysis catheter. Ex-smoker status was significantly associated with reduced risk.
Collapse
Affiliation(s)
- Kylie Martin
- Department of Nephrology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Yves S Poy Lorenzo
- Pharmacy Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.,University of Melbourne, Melbourne Medical School, Department of Medicine, Fitzroy, Victoria, Australia
| | - Po Yee Mia Leung
- Department of Nephrology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Sheri Chung
- Pharmacy Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Emmet O'flaherty
- Department of Nephrology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Nuala Barker
- Department of Nephrology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Francesco Ierino
- Department of Nephrology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.,University of Melbourne, Melbourne Medical School, Department of Medicine, Fitzroy, Victoria, Australia
| |
Collapse
|
31
|
Perondi F, Petrescu VF, Fratini F, Brovida C, Porciello F, Ceccherini G, Lippi I. Bacterial colonization of non-permanent central venous catheters in hemodialysis dogs. Heliyon 2020; 6:e03224. [PMID: 32021926 PMCID: PMC6994843 DOI: 10.1016/j.heliyon.2020.e03224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/02/2019] [Accepted: 01/10/2020] [Indexed: 01/02/2023] Open
Abstract
Non-permanent central venous catheters (CVCs), are the most commonly used vascular access in veterinary patients undergoing hemodialysis. In human dialysis patients, CVC infection represents a common cause of morbidity and mortality. The aim of this retrospective observational study was to evaluate the prevalence of bacterial colonization of CVCs in dogs submitted to hemodialysis treatment at time of CVC removal. The CVCs of all dogs submitted to hemodialysis (n = 23) at the Veterinary Teaching Hospital ''Mario Modenato'' of the University of Pisa between January 2015 and December 2016 were considered. For all dogs, data regarding signalment, reason for hemodialysis treatment, duration of catheterization (≤15 or >15 days), CVC complications, and 30-day survival were considered. Statistical analysis was performed using Graph Pad Prism™. Five over 23 dogs (22%) showed positive bacterial culture of CVC (+), and 18/23 dogs (78%) negative culture of CVC (-). The most prevalent microorganism was Staphylococcus Spp (3/5; 60%). No significant difference was found in the prevalence of CVC infection according to age, gender, reason for hemodialysis, CVC complications, duration of catheterization, and outcome. No statistically significant difference (p = 0.64) in survival curves was reported at log rank analysis between dogs with CVC - and CVC +. The prevalence of bacterial CVC contamination in our dialysis dogs showed relatively low. Exclusive use of CVC for hemodialysis, good hygiene practice during CVC management, and use of chlorhexidine as an antiseptic should be strongly encouraged.
Collapse
Affiliation(s)
- Francesca Perondi
- Department of Veterinary Medicine, University of Pisa, Via Livornese lato monte, San Piero a grado, 56122, Pisa, Italy
- Corresponding author.
| | - Vasilica-Flory Petrescu
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126, Perugia, Italy
| | - Filippo Fratini
- Department of Veterinary Medicine, University of Pisa, Via Livornese lato monte, San Piero a grado, 56122, Pisa, Italy
| | - Claudio Brovida
- ANUBI Ospedale per Animali da Compagnia, Strada Genova 299/A, 10024, Monalieri, Italy
| | - Francesco Porciello
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126, Perugia, Italy
| | - Gianila Ceccherini
- Department of Veterinary Medicine, University of Pisa, Via Livornese lato monte, San Piero a grado, 56122, Pisa, Italy
| | - Ilaria Lippi
- Department of Veterinary Medicine, University of Pisa, Via Livornese lato monte, San Piero a grado, 56122, Pisa, Italy
| |
Collapse
|
32
|
Auguste BL, Girsberger M, Kennedy C, Srithongkul T, McGrath-Chong M, Bargman J, Chan CT. Are adverse events in newly trained home dialysis patients related to learning styles? A single-centre retrospective study from Toronto, Canada. BMJ Open 2020; 10:e033315. [PMID: 31964671 PMCID: PMC7045245 DOI: 10.1136/bmjopen-2019-033315] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Home haemodialysis (HD) and peritoneal dialysis (PD) have seen growth in utilisation around the globe over the last few years. However, home dialysis, with its attendant technical complexity and risk of adverse events continues to pose challenges for wider adoption. We examined whether differences in patients' learning styles are associated with differing risk of adverse events in both home HD and PD patients. DESIGN Retrospective cohort study. SETTING Tertiary care hospital in Toronto, Ontario, Canada. PARTICIPANTS One hundred and eighteen prevalent adult (≥18 years) home dialysis patients (40 PD and 78 home HD) were enrolled. Patients on home dialysis for less than 6 months or receiving home nursing assistance for dialysis were excluded from the study. INTERVENTIONS Enrolled patients completed (VARK) Visual, Aural, Reading-writing and Kinesthetic questionnaires to determine learning styles. PRIMARY AND SECONDARY OUTCOME MEASURES Home HD and PD adverse events were identified within 6 months of completing home dialysis training. Event rates were then stratified and compared according to learning styles. RESULTS Thirty patients had a total of 53 adverse events. We used logistic regression analysis to determine unadjusted and adjusted ORs for a single adverse event. Non-visual learners were 4.35 times more likely to have an adverse event (p=0.001). After adjusting for age, gender, dialysis modality, training duration, dialysis vintage, prior renal replacement therapy, visual impairment, education and literacy, an adverse event was still four times more likely among non-visual learners compared to visual learners (p=0.008). A subgroup analysis of home HD patients showed adverse events were more likely among non-visual learners (OR 11.1; p=0.003), whereas PD patients showed a trend for more adverse events in non-visual learners (OR: 1.60; p=0.694). CONCLUSIONS Different learning styles in home dialysis patients exist. Visual learning styles are associated with fewer adverse events in home dialysis patients within the first 6 months of completing training. Individualisation of home dialysis training by learning style is warranted.
Collapse
Affiliation(s)
- Bourne Lewis Auguste
- Medicine; Division of Nephrology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Medicine; Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
| | - Michael Girsberger
- Medicine; Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Claire Kennedy
- Medicine; Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | | | | | - Joanne Bargman
- Medicine; Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
- Medicine; Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Christopher T Chan
- Medicine; Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
33
|
Hojs N, Fissell WH, Roy S. Ambulatory Hemodialysis-Technology Landscape and Potential for Patient-Centered Treatment. Clin J Am Soc Nephrol 2019; 15:152-159. [PMID: 31727617 PMCID: PMC6946084 DOI: 10.2215/cjn.01970219] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
CKD is a worldwide health problem and the number of patients requiring kidney replacement therapy is rising. In the United States, most patients with ESKD rely on in-center hemodialysis, which is burdensome and does not provide the same long-term benefits as kidney transplantation. Intensive hemodialysis treatments have demonstrated improved clinical outcomes, but its wider adoption is limited by equipment complexity and patient apprehension. Ambulatory devices for hemodialysis offer the potential for self-care treatment outside the clinical setting as well as frequent and prolonged sessions. This article explains the motivation for ambulatory hemodialysis and provides an overview of the necessary features of key technologies that will be the basis for new wearable and implantable devices. Early work by pioneers of hemodialysis is described followed by recent experience using a wearable unit on patients. Finally, ongoing efforts to develop an implantable device for kidney replacement and its potential for implantable hemodialysis are presented.
Collapse
Affiliation(s)
- Nina Hojs
- Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy and Medicine, University of California, San Francisco, San Francisco, California.,Department of Nephrology, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor, Slovenia; and
| | - William H Fissell
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shuvo Roy
- Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy and Medicine, University of California, San Francisco, San Francisco, California;
| |
Collapse
|
34
|
Hoggard JG, Blair RD, Montero M, Moustafa MA, Newman J, Pergola PE, Saucier N, Wheeler CJ, Mermel LA, Ross JR, Beserab AD. Clinical outcomes associated with the use of the NexSite hemodialysis catheter with new exit barrier technology: Results from a prospective, observational multi-center registry study. PLoS One 2019; 14:e0223285. [PMID: 31589644 PMCID: PMC6779244 DOI: 10.1371/journal.pone.0223285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 09/17/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose Decreasing the risk of catheter related bloodstream infections (CRBSIs) remains a key focus for improving outcomes and reducing cost of care for hemodialysis (HD) patients. Recent studies demonstrate CRBSI rates can be improved by managing bacterial colonization at the catheter exit site. Herein we present the results of a study documenting the clinical performance of the NexSite HD catheter, a new tunneled central venous catheter which incorporates Exit Site Management (ESM) technology. Methods We conducted an observational study using a prospective, multi-center registry of HD patients implanted with the NexSite HD catheter. The primary endpoint for the study was CRBSI rate for a period up to 180-days following catheter placement. Secondary endpoints included device placement success rate, exit site healing, development of an exit site or tunnel infection, and early or late non-infectious catheter-related complications. All reasons for early non-elective catheter removal were recorded. Results A total of 115 HD patients at 6 sites were included in the final analysis. Cumulative catheter use was 10,924 days with a mean duration of 95 days. Seven patients experienced CRBSIs during the study period resulting in a CRBSI rate of 0.64 per 1,000 catheter-days. Seventy-four patients (64.3%) had either elective catheter removal (n = 56) or utilized the catheter for the entire 180-day observation period (n = 18). Thirty-five patients (30%) underwent non-elective device removal either due to CRBSI (n = 5), low flow (n = 16), exit site issues (n = 7), or for other causes (n = 7). Six patients died during the observation period with 1 death due to CRBSI-associated complications and the remaining 5 deaths attributed to non-device related causes. Conclusion Our findings demonstrate that the NexSite HD catheter equipped with ESM technology can achieve a CRBSI rate in compliance with the NKF KDOQI (National Kidney Foundation Kidney Disease Outcome Quality Initiatives) Clinical Performance Guidelines stated goal of less than 1.0/1,000 catheter-days when used in hemodialysis patients using current standard of care nursing protocols.
Collapse
Affiliation(s)
- Jeffrey G. Hoggard
- Capital Nephrology Associates, Raleigh, North Carolina, United States of America
- * E-mail:
| | - Richard D. Blair
- Eastern Nephrology, New Bern, North Carolina, United States of America
| | - Manuel Montero
- Eastern Nephrology, New Bern, North Carolina, United States of America
| | - Moustafa A. Moustafa
- South Carolina Nephrology and Hypertension Center, Orangeburg, South Carolina, United States of America
| | - Joseph Newman
- Eastern Nephrology, Greenville, North Carolina, United States of America
| | - Pablo E. Pergola
- Renal Associates PA, San Antonio, Texas, United States of America
| | - Nathan Saucier
- Eastern Nephrology, New Bern, North Carolina, United States of America
| | - Clarence J. Wheeler
- Kidney and Blood Pressure Clinic of Lubbock, Lubbock, Texas, United States of America
| | - Leonard A. Mermel
- Division of Infectious Diseases, Rhode Island Hospital and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - John R. Ross
- Access Connections LLC, Orangeburg, South Carolina, United States of America
| | - Anatole D. Beserab
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, United States of America
| |
Collapse
|
35
|
Sánchez Villar I, Lorenzo Sellares V. ¿Se infectan más los catéteres tunelizados para hemodiálisis cuando los pacientes ingresan en el hospital? ENFERMERÍA NEFROLÓGICA 2019. [DOI: 10.4321/s2254-28842019000300005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
La infección de los catéteres para hemodiálisis constituye una de las causas de mayor morbimortalidad. La hipótesis intuitiva de que los catéteres se infectan más durante la hospitalización no ha sido verificada en la literatura.
Objetivo: Conocer si la hospitalización es un factor de riesgo de bacteriemia relacionada con catéter.
Material y Método: Análisis retrospectivo de las bacteriemias asociadas a catéter durante un período de 4 años de un centro periférico extrahospitalario de hemodiálisis dependiente de un Servicio de Nefrología de un hospital de tercer nivel durante el período 2014-2017.
Se recogieron los tiempos de empleo de catéteres y las bacteriemias relacionadas con catéter divididos en 2 escenarios: Hospital y centro periférico.
Se aplicó el Modelo de Regresión de Poisson para comparar las bacteriemias Hospital vs centro periférico. Un mismo paciente pudo padecer bacteriemia más de una vez y en los dos escenarios.
Resultados: Se emplearon 361 catéteres en 174 pacientes con tiempo total de uso 91.491 días, con 103 episodios de bacteriemia.Tasas de bacteriemias: hospitalizado 7,81/1000 días/catéter y centro periférico 0,81/1000 días/catéter.
El riesgo de sufrir bacteriemia se multiplicó por 9,6 durante la hospitalización vs centro periférico (p
Collapse
|
36
|
Gork I, Gross I, Cohen MJ, Schwartz C, Moses AE, Elhalel MD, Benenson S. Access-related infections in two haemodialysis units: results of a nine-year intervention and surveillance program. Antimicrob Resist Infect Control 2019; 8:105. [PMID: 31244996 PMCID: PMC6582529 DOI: 10.1186/s13756-019-0557-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/10/2019] [Indexed: 01/08/2023] Open
Abstract
Background Access-related infections are a major cause of morbidity and mortality in haemodialysis patients. Our goal was to decrease the rate of these infections by implementing an intervention and surveillance program. Methods This intervention took place in two haemodialysis units (Units A and B) and was a joint effort by the haemodialysis staff and the unit for infection prevention and control. It included reviewing the work methods and work space, observations on compliance with standard precautions and handling of the vascular access, creating a checklist and a designated kit for handling the vascular access and prospective surveillance of access-related infections. Results During a nine-year period, the haemodialysis units A and B treated 4471 and 7547 patients (mean number of patients per year: 497 (range 435–556) and 839 (range 777–1055), respectively). For most patients, the procedure was done through an arteriovenous fistula (66.7%, range 50.3–81.5%). The access-related infection rate decreased significantly in both haemodialysis units: from 3 to 0.9% (trend: p < 0.05, linear regression: p < 0.001) in Unit A and from 0.9 to 0.2% (trend: p < 0.05, linear regression: p = 0.01) in Unit B. Conclusions An intervention which included introduction of a checklist and designated kit, together with ongoing surveillance and feedback, resulted in a significant decrease in the access-related infection rates in both haemodialysis units.
Collapse
Affiliation(s)
- Ittamar Gork
- 1Department of Nephrology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ilana Gross
- 2Department of Clinical Microbiology and Infectious Diseases, Hadassah - Hebrew University Medical Center, POB 12000, 9112001 Jerusalem, Israel
| | - Matan J Cohen
- 2Department of Clinical Microbiology and Infectious Diseases, Hadassah - Hebrew University Medical Center, POB 12000, 9112001 Jerusalem, Israel
| | - Carmela Schwartz
- 2Department of Clinical Microbiology and Infectious Diseases, Hadassah - Hebrew University Medical Center, POB 12000, 9112001 Jerusalem, Israel
| | - Allon E Moses
- 2Department of Clinical Microbiology and Infectious Diseases, Hadassah - Hebrew University Medical Center, POB 12000, 9112001 Jerusalem, Israel
| | | | - Shmuel Benenson
- 2Department of Clinical Microbiology and Infectious Diseases, Hadassah - Hebrew University Medical Center, POB 12000, 9112001 Jerusalem, Israel
| |
Collapse
|
37
|
Mohamed H, Ali A, Browne LD, O'Connell NH, Casserly L, Stack AG, Hussein WF. Determinants and outcomes of access-related blood-stream infections among Irish haemodialysis patients; a cohort study. BMC Nephrol 2019; 20:68. [PMID: 30808313 PMCID: PMC6390569 DOI: 10.1186/s12882-019-1253-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 02/11/2019] [Indexed: 11/29/2022] Open
Abstract
Background Infections are the second leading cause of death and hospitalisation among haemodialysis (HD) patients. Rates of access-related bloodstream infections (AR-BSI) are influenced by patient characteristics and local protocols. We explored factors associated with AR-BSI in a contemporary cohort of HD patients at a tertiary nephrology centre. Methods A retrospective cohort of 235 chronic HD patients was identified from a regional dialysis programme between Jan 2015 and Dec 2016. Data on demographics, primary renal disease, comorbid conditions and dialysis access type were obtained from the Kidney Disease Clinical Patient Management System (KDCPMS). Data on blood cultures were captured from the microbiology laboratory. Poisson regression with robust variance estimates was used to compare infection rates and relative risk of AR-BSI according to the site and type of vascular access. Results The mean age was 65 (± 15) years, 77% were men, and the median follow up was 19 months (IQR: 10–24 months), accumulating 2030 catheter-months and 1831 fistula-months. Overall rates of AR-BSI were significantly higher for central venous catheter (CVC) compared to arteriovenous fistula (AVF), (2.22, 95% (CI): 1.62–2.97) versus 0.11 (0.01–0.39) per 100 patient-months respectively), with a rate ratio of 20.29 (4.92–83.66), p < 0.0001. This pattern persisted across age, gender and diabetes subgroups. Within the CVC subgroup, presence of a femoral CVC access was associated with significantly higher rates of AR-BSI (adjusted RR 4.93, 95% CI: 2.69–9.01). Older age (75+ versus < 75 years) was not associated with significant differences in rates of AR-BSI in the unadjusted or the adjusted analysis. Coagulase negative Staphylococcus (61%) and Staphylococcus aureus (23%) were the predominant culprits. AR-BSIs resulted in access loss and hospitalisation in 57 and 72% of events respectively, and two patients died with concurrent AR-BSI. Conclusions Rates of AR-BSI are substantially higher in CVC than AVF in contemporary HD despite advances in catheter design and anti-infective protocols. This pattern was consistent in all subgroups. The policy of AVF preference over CVC should continue to minimise patient morbidity while at the same time improving anti-infective strategies through better care protocols and infection surveillance. Electronic supplementary material The online version of this article (10.1186/s12882-019-1253-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Husham Mohamed
- Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Alaa Ali
- Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Leonard D Browne
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Nuala H O'Connell
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland.,Division of Microbiology, Department of Medicine, University Hospital Limerick, Limerick, Ireland
| | - Liam Casserly
- Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Austin G Stack
- Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Ireland. .,Graduate Entry Medical School, University of Limerick, Limerick, Ireland. .,Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Wael F Hussein
- Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| |
Collapse
|
38
|
Landry DL, Braden GL, Yee J. Hemodialysis Catheter Device Protection: Damned if We Do; Patients Are Damned if We Don't. Adv Chronic Kidney Dis 2019; 26:1-4. [PMID: 30876611 DOI: 10.1053/j.ackd.2018.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
39
|
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
|
40
|
Brunelli SM, Van Wyck DB, Njord L, Ziebol RJ, Lynch LE, Killion DP. Cluster-Randomized Trial of Devices to Prevent Catheter-Related Bloodstream Infection. J Am Soc Nephrol 2018; 29:1336-1343. [PMID: 29472415 DOI: 10.1681/asn.2017080870] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 02/01/2018] [Indexed: 11/03/2022] Open
Abstract
Central venous catheters (CVCs) contribute disproportionately to bloodstream infection (BSI) and, by extension, to infection-related hospitalization, mortality, and health care costs in patients undergoing dialysis. Recent product advancements may reduce BSIs, but a sufficiently powered comparative-effectiveness study is needed to facilitate evidence-based patient care decisions. In a 13-month, prospective, cluster-randomized, open-label trial, we compared BSI rates in facilities using ClearGuard HD antimicrobial barrier caps (ClearGuard group) with those in facilities using Tego hemodialysis connectors plus Curos disinfecting caps (Tego+Curos group). Forty DaVita dialysis facilities in the United States were pair-matched by BSI rate, number of patients using CVCs, and geographic location, and then cluster randomized 1:1. We enrolled all adult patients undergoing dialysis with CVCs at these facilities, except those allergic to heparin or chlorhexidine. Overall, 1671 patients participated in the study, accruing >183,000 CVC-days. The study outcome was positive blood culture (PBC) rate as an indicator of BSI rate. We calculated results at the cluster level and adjusted for the facility cluster effect. During a 3-month run-in period immediately before study interventions, the groups had similar BSI rates (P=0.8). During the 13-month intervention period that immediately followed, the ClearGuard group had a BSI rate significantly lower than that of the Tego+Curos group (0.28 versus 0.75 PBCs per 1000 CVC-days, respectively; P=0.001). No device-related adverse events were reported. In conclusion, compared with Tego connectors plus Curos caps, ClearGuard HD antimicrobial barrier caps significantly lowered the rate of catheter-related BSIs in patients undergoing hemodialysis using CVCs, representing an important advancement in hemodialysis patient care.
Collapse
|
41
|
Peng L, Qiu Y, Huang Z, Xia C, Dai C, Zheng T, Li Z. Numerical Simulation of Hemodynamic Changes in Central Veins after Tunneled Cuffed Central Venous Catheter Placement in Patients under Hemodialysis. Sci Rep 2017; 7:15955. [PMID: 29162830 PMCID: PMC5698485 DOI: 10.1038/s41598-017-12456-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/08/2017] [Indexed: 02/05/2023] Open
Abstract
The tunneled central venous catheter (CVC) plays an important role for hemodialysis patients, but CVC-related thrombosis in the central veins remain problematic. This study is the first try to numerically find out what hemodynamic parameters are predisposed to the initiation and formation of thrombus after CVC insertion. And the potential relationship between hemodynamic parameters and the incidence rates of thrombosis occurrence was explored. The results revealed that the CVC insertion led to a significant increase of hydraulic resistance, wide-ranging abnormally high wall shear stress (WSS), and a great loss of flow rotation in the vein. Moreover, the clinical data showed that thrombosis mainly occurred at sections where most blood flow lost spiral rotation after the CVC insertion, but no corresponding match was observed between the occurrence of thrombosis and the flow velocity or WSS. We speculate that the destruction of the flow rotation in the central vein is a precursor to the thrombus formation around CVC, and an introduction of spiral flow with the CVC insertion may possibly help to protect the central vein from thrombosis. Further animal and clinical experiments should be carried out to test and verify this speculation.
Collapse
Affiliation(s)
- Liqing Peng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yue Qiu
- Department of Applied Mechanics, Sichuan University, Chengdu, 610065, China
| | - Zhongyi Huang
- Department of Applied Mechanics, Sichuan University, Chengdu, 610065, China
| | - Chunchao Xia
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, China.,Vascular Surgery Department, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Chenzhong Dai
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Tinghui Zheng
- Department of Applied Mechanics, Sichuan University, Chengdu, 610065, China.
| | - Zhenlin Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, China.
| |
Collapse
|
42
|
Miller LM, MacRae JM, Kiaii M, Clark E, Dipchand C, Kappel J, Lok C, Luscombe R, Moist L, Oliver M, Pike P, Hiremath S. Hemodialysis Tunneled Catheter Noninfectious Complications. Can J Kidney Health Dis 2017. [PMID: 28270922 DOI: 10.1177/2054358116669130.] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Noninfectious hemodialysis catheter complications include catheter dysfunction, catheter-related thrombus, and central vein stenosis. The definitions, causes, and treatment strategies for catheter dysfunction are reviewed below. Catheter-related thrombus is a less common but serious complication of catheters, requiring catheter removal and systemic anticoagulation. In addition, the risk factors, clinical manifestation, and treatment options for central vein stenosis are outlined.
Collapse
Affiliation(s)
- Lisa M Miller
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Jennifer M MacRae
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Mercedeh Kiaii
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Edward Clark
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | | | - Joanne Kappel
- Faculty of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Charmaine Lok
- Faculty of Medicine, University Health Network, University of Toronto, Ontario, Canada
| | - Rick Luscombe
- Department of Nursing, Providence Health Care, Vancouver, British Columbia, Canada
| | - Louise Moist
- Department of Medicine, University of Western Ontario, London, Canada
| | - Matthew Oliver
- Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Pamela Pike
- Department of Medicine, Memorial University, Saint John's, Newfoundland and Labrador, Canada
| | | | | |
Collapse
|
43
|
Miller LM, MacRae JM, Kiaii M, Clark E, Dipchand C, Kappel J, Lok C, Luscombe R, Moist L, Oliver M, Pike P, Hiremath S. Hemodialysis Tunneled Catheter Noninfectious Complications. Can J Kidney Health Dis 2016; 3:2054358116669130. [PMID: 28270922 PMCID: PMC5332086 DOI: 10.1177/2054358116669130] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/04/2016] [Indexed: 12/19/2022] Open
Abstract
Noninfectious hemodialysis catheter complications include catheter dysfunction, catheter-related thrombus, and central vein stenosis. The definitions, causes, and treatment strategies for catheter dysfunction are reviewed below. Catheter-related thrombus is a less common but serious complication of catheters, requiring catheter removal and systemic anticoagulation. In addition, the risk factors, clinical manifestation, and treatment options for central vein stenosis are outlined.
Collapse
Affiliation(s)
- Lisa M Miller
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Jennifer M MacRae
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Mercedeh Kiaii
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Edward Clark
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | | | - Joanne Kappel
- Faculty of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Charmaine Lok
- Faculty of Medicine, University Health Network, University of Toronto, Ontario, Canada
| | - Rick Luscombe
- Department of Nursing, Providence Health Care, Vancouver, British Columbia, Canada
| | - Louise Moist
- Department of Medicine, University of Western Ontario, London, Canada
| | - Matthew Oliver
- Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Pamela Pike
- Department of Medicine, Memorial University, Saint John's, Newfoundland and Labrador, Canada
| | | | | |
Collapse
|
44
|
Clark E, Kappel J, MacRae J, Dipchand C, Hiremath S, Kiaii M, Lok C, Moist L, Oliver M, Miller LM. Practical Aspects of Nontunneled and Tunneled Hemodialysis Catheters. Can J Kidney Health Dis 2016; 3:2054358116669128. [PMID: 28270920 PMCID: PMC5332079 DOI: 10.1177/2054358116669128] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/04/2016] [Indexed: 12/20/2022] Open
Abstract
Nontunneled hemodialysis catheters (NTHCs) are typically used when vascular access is required for urgent renal replacement therapy. The preferred site for NTHC insertion in acute kidney injury is the right internal jugular vein followed by the femoral vein. When aided by real-time ultrasound, mechanical complications related to NTHC insertion are significantly reduced. The preferred site for tunneled hemodialysis catheters placement is the right internal jugular vein followed by the left internal jugular vein. Ideally, the catheter should be inserted on the opposite side of a maturing or planned fistula/graft. Several dual-lumen, large-diameter catheters are available with multiple catheter tip designs, but no one catheter has shown significant superior performance.
Collapse
Affiliation(s)
- Edward Clark
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Joanne Kappel
- Faculty of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Jennifer MacRae
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | | | | | - Mercedeh Kiaii
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Charmaine Lok
- Faculty of Medicine, University Health Network, University of Toronto, Ontario, Canada
| | - Louise Moist
- Department of Medicine, University of Western Ontario, London, Canada
| | - Matthew Oliver
- Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Lisa M Miller
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | | |
Collapse
|