Subclavian hemodialysis catheter infections: a prospective, randomized trial of an attachable silver-impregnated cuff for prevention of catheter-related infections

OBJECTIVE

To determine if an attachable silver-impregnated cuff is effective in reducing subclavian hemodialysis catheter-related infections.

DESIGN

Prospective, randomized, nonblinded study.

SETTING

Community teaching hospital.

PATIENTS

One hundred one acute and chronic renal failure patients requiring subclavian venipuncture and catheterization. After randomization, 47 patients underwent subclavian catheterization with a silver-impregnated cuff (Ag-CC), and 54 patients had routine catheter (RC) placements.

MEASUREMENTS

Multiple presumed predictor variables for catheter-related infections, exit site infection rate, bacteremia rates, and semiquantitative cultures of all catheters.

Subclavian hemodialysis catheter infections

One hundred sixteen subclavian hemodialysis catheter placements in 88 patients were prospectively evaluated for catheter-related infections. Semiquantitative culture techniques and a rigid infection control protocol were used. The overall catheter colonization rate was 21.6% and catheter-associated bacteremia occurred in 9.4%. Catheters removed from febrile patients had much higher colonization (48.3%) and bacteremia (34.5%) rates. In a randomized study comparing infection rates in catheters tunneled subcutaneously or not tunneled, there was no significant difference in the incidence of infection. Catheters inserted over a guidewire to replace clotted or malfunctioning catheters were not associated with higher infection rates.

Mesenteric ischemia in chronic dialysis patients

6 chronic dialysis patients with acute mesenteric ischemia are described. 3 had nonocclusive infarctions, and 3 had occlusive disease. 5 of the patients had episodes of severe hypotension or hypovolemia immediately before the onset of abdominal symptoms. All patients had leukocyte counts of greater than 12,000 on admission, and 4 had stools positive for occult blood. The characteristic features of dialysis-induced hypotension followed by nonspecific abdominal symptoms and leukocytosis are emphasized.

Renal failure in Wegener's granulomatosis: recovering following dialysis and cyclophosphamide-prednisone therapy

Two patients with Wegener's granulomatosis, crescentic glomerulonephritis, and severe renal failure are described. Both patients required hemodialysis for control of uremic symptoms. Cyclophosphamide-prednisone therapy successfully controlled the extra-renal manifestations of their disease and reversed the renal failure so that dialysis could be discontinued.

Autosomal or X-linked recessive syndrome of congenital lymphedema, hypoparathyroidism, nephropathy, prolapsing mitral valve, and brachytelephalangy

Two brothers were found to have an unusual congenital syndrome of lymphedema, pulmonary lymphagiectasia, hypoparthyroidism, hereditary nephropathy, prolapsing mitral valve, and other somatic abnormalities.