A study of outcome and complications associated with temporary hemodialysis catheters in a Nigerian dialysis unit

Abstract

Hemodialysis (HD) catheters are commonly used as temporary vascular access in patients with kidney failure who require immediate HD. The use of these catheters is limited by complications such as infections, thrombosis resulting in poor blood flow. We studied the complications and outcomes of nontunneled catheters used for vascular access in our dialysis unit. The records of all patients, with renal failure who were dialyzed over a two-year period and had a double lumen nontunneled catheter inserted, were retrieved. Catheter insertion was carried out under ultrasound guidance using the modified Seldinger technique. The demographic data of patients, etiology of chronic kidney disease, and complications and outcomes of these catheters were noted. Fifty-four patients with mean age 43.7 ± 15.8 years had 69 catheters inserted for a cumulative total of 4047 catheter-days. The mean catheter patency was 36.4 ± 37.2 days (range: 1-173 days). Thrombosis occluding the catheters was the most common complication and occurred in 58% of catheters leading to catheter malfunction, followed by infections in18.8% of catheters. During follow-up, 30 (43.5%) catheters were removed, 14 (20.3%) due to catheter malfunction, eight (11.6%) due to infection, five (7.2%) elective removal, and three (4.3%) due to damage. Thrombotic occlusion of catheters was a major limiting factor to the survival of HD catheters. Improvement in catheter patency can be achieved with more potent lock solutions.

Fast and furious: a retrospective study of catheter-associated bloodstream infections with internal jugular nontunneled hemodialysis catheters at a tropical center

“…The majority of CABSIs in our study were Gram-negative. This phenomenon has also been reported from other centers in South Asia [19, 20], while the rest of the world [6, 9, 10, 12, 13, 17, 21–23] encounters predominantly Gram-positive CABSIs. Patients who developed a CABSI did so at a median of 24.5 days after NTHC insertion, while the median duration of catheter use for the non-CABSI group was 43 days.…”

“…Our CABSI incidence rate of 7.4 episodes per 1000 catheter days is higher than studies from North America, Europe and Africa that have reported jugular NTHC CABSI incidence rates ranging from 1.67 to 5.6/1000 catheter days [9–13]. We used the CDC definition of CABSI rather than the more stringent Infectious disease Society of America (IDSA) criteria for definite catheter-related bloodstream infection or CRBSI [14].…”

“…The latter has been criticized for being labor intensive, expensive and impractical and has a low sensitivity and accuracy for the diagnosis of HD catheter-related infections [15, 16]. CRBSI rates using these criteria are up to 18% lower than CABSI rates using the CDC definition [9, 17]. This is illustrated by the fact that among the studies alluded to earlier, the highest incidence rate was reported by a study from The Netherlands [10] that used the same CABSI definition we did.…”

“…Almost half the study population received a single dose of IV cefazolin as surgical antibiotic prophylaxis prior to AVF construction during the follow-up period. We found IV cefazolin to be protective against CABSI, probably because of its action against Gram-positive organisms, which are the most common cause of CABSIs worldwide [6, 9, 10].…”

Catheter-Related Bloodstream Infections and Catheter Colonization among Haemodialysis Patients: Prevalence, Risk Factors, and Outcomes

“…The difference in the prevalence may be due to variation in the study designs and different definitions use of CRBSI and CC. Previous studies have shown that the CRBSI rates using the IDSA criteria are usually about 18% lower than the CRBSI rates using the CDC definition [ 11 , 12 ].…”