Femoral vs Jugular Venous Catheterization and Risk of Nosocomial Events in Adults Requiring Acute Renal Replacement Therapy

Quasi-Experimental Study of Sodium Citrate Locks and the Risk of Acute Hemodialysis Catheter Infection among Critically Ill Patients

“…In a pilot (n ϭ 78) open-label, single-center, randomized controlled trial among critically ill patients requiring RRT, Hermite et al (5) reported a significantly longer time for central catheter-associated bloodstream infection (CLABSI) (6) to occur in the citrate locking group (20 days versus 14 days in the saline solution locking group; hazard ratio [HR], 2.8; 95% confidence interval [CI], 1.0 to 7.6; P ϭ 0.04). Of note, the incidence of CLABSI in this study (5) was Ͼ24 per 1,000 catheter-days and contrasts with the incidence of CRBSI found in the multicenter Cathedia cohort (1.9 per 1,000 catheterdays) (7) and in the study by Skofic et al (8) conducted using the same type of patients (1.6 per 1,000 catheter-days). Whether citrate lock is more effective than saline solution or heparin lock in intensive care unit (ICU) settings and whether it is associated with a lower incidence of CRBSI remain unclear (9).…”

“…Between the two time periods (2004 to 2007 for the Cathedia historical group and 2011 to 2012 for the Clock group), the effectiveness of the implementation of simple "bundle measures" to prevent the risk of CRBSI in patients admitted to intensive care units (38) could favor the CLock group, independently of the locking solution used. Maximal barrier precautions for catheter insertion and maintenance were already in use during the control period, chlorhexidine skin antisepsis was not available, avoidance of the femoral vein for vascular access was not relevant compared to avoidance of the jugular vein (7,39), and exposures to central venous access were similar between the two periods. Moreover, the patient risk factors (2) and interventions that could increase or decrease the risk of catheter infection were prospectively monitored and standardized.…”

“…Given the retrospective and quasi-experimental nature of this analysis, no additional IRB approval was requested. Details of the dialysis catheters used in the Cathedia study were described elsewhere (7) and were consistent with those used in the CLock study. For the present analysis, we excluded patients who exclusively received continuous RRT and catheters that were not inserted first in the ICU (10).…”

“…(i) Catheter-tip colonization. The primary endpoint of this study was catheter-tip colonization, defined as cultures with Ն10 3 CFU per millimeter of growth, according to the Brun-Buisson vortex technique without neutralizing broth (7).…”

Impacto dos fatores infecciosos e mecânicos na sobrevida do cateter temporário para hemodiálise em pacientes cardiopatas com injúria renal aguda

“…Outro impasse quanto à escolha do sítio venoso, refere-se ao risco de estenose associado à veia subclávia e o risco de infecção associado ao cateter na veia femoral 31 .…”