Inserting tunnelled hemodialysis catheters using elective guidewire exchange from nontunnelled catheters: Is there a greater risk of infection when compared with new‐site replacement?

Abstract

The objective is to evaluate bacteremia outcomes and survival rates when using guidewire exchange to place tunnelled hemodialysis catheter (THDC) compared with a new-site replacement. Retrospectively, all patients were identified who received a THDC between January 1, 2000 and January 1, 2007. Any THDC having received antibiotic line locks or tunnel-to-tunnel exchange were excluded. This left 408 THDC placed in 329 patients: 46 guidewire exchange, 362 new-site replacement. Bacteremia rate from the new-site insertion group was 3.0 per 1000 catheter days, the guidewire exchange group demonstrated a rate of 2.8 per 1000 catheter days. Local infection rates did not differ between the groups at 1.2 per 1000 catheters days. The actuarial catheter survival rates using Kaplan-Meier survival analysis demonstrated no difference between the 2 groups. The placing of tunnelled cuffed hemodialysis catheters to replace temporary catheters using a guidewire exchange did not contribute to further episodes of sepsis and has the advantage of preserving venous access and minimizing invasive procedures for the patient.

The microbiological and clinical outcome of guide wire exchanged versus newly inserted antimicrobial surface treated central venous catheters

“…In contrast to the above positions, several other observational studies reported that GWX of a CVC was microbiologically safe [11,15,30,34]. Unfortunately, in the absence of randomized trials or contemporaneous controls, these reports were confounded by selection bias and provided only weak evidence for or against GWX-CVCs.…”

How to deal with dialysis catheters in the ICU setting

“…Several studies suggest that catheter guidewire exchange in conjunction with systemic anti infectious treatment is an acceptable way to manage mild catheter-related infections in chronic hemodialysis patients. This strategy, called the salvage of site approach, has a low complication rate with no increase in bacteremia episodes and provides similar longevity to new-site placements [17,67-70]. In ICU patients with suspected DC infection, there is a lack of evidence to support or discourage such a strategy.…”

Guidewire Catheter Exchange in Pediatric Oncology: Indications, Postoperative Complications, and Outcomes

“…However, the use of CVC is associated with complications, including infection, catheter malfunction, and thrombosis, necessitating their replacement. This can be achieved with de novo percutaneous placement of a new device or by using the Seldinger technique to change the catheter over a guidewire . Guidewire catheter exchange (GCE) involves exchanging a previous catheter over a guidewire, thereby using the same venous access.…”

“…Catheter‐related complications, such as malfunction and displacement, and patient/family preferences are also indications for GCE. Different studies performed in adult populations have suggested that GCE is associated with a low complication rate and without an increased risk of infection . However, these findings have not been confirmed in children with malignancies.…”