Use of the Tego needlefree connector is associated with reduced incidence of catheter-related bloodstream infections in hemodialysis patients

Abstract

Background and objectivesCatheter-related bloodstream infections (CRBSIs) are common in hemodialysis patients using central venous catheters, and catheter occlusion also occurs frequently. The Tego needlefree connector was developed to reduce the incidence of these complications; however, existing studies of its effectiveness and safety are limited.Materials and methodsThis retrospective analysis compared outcomes among patients of a large dialysis organization receiving in-center hemodialysis using a central venous catheter with either the Tego connector or standard catheter caps between October 1 and June 30, 2013. Incidence rates for intravenous (IV) antibiotic starts, receipt of an IV antibiotic course, positive blood cultures, mortality, and missed dialysis treatments were calculated, and incidence-rate ratios (IRRs) were estimated using Poisson regression models. Utilization of erythropoiesis-stimulating agents (ESAs) and thrombolytics was described for each patient-month and compared using mixed linear models. Models were run without adjustment, adjusted for covariates that were imbalanced between cohorts, or fully adjusted for all potential confounders.ResultsThe analysis comprised 10,652 Tego patients and 6,493 controls. Tego use was independently associated with decreased risk of CRBSI, defined by initiation of IV antibiotics (adjusted IRR 0.92, 95% confidence interval [CI] 0.87–0.97) or initiation of IV antibiotic course (adjusted IRR 0.89, 95% CI 0.84–0.95). Tego use was independently associated with decreased rate of missed dialysis treatments (adjusted IRR 0.98, 95% CI 0.97–1.00); no significant difference between Tego and control cohorts was observed with respect to mortality. Tego use was associated with decreased likelihood of thrombolytic use (adjusted per-month probability of 5.6% versus 6.2% for controls) and lower utilization of ESAs in study months 7–9.ConclusionUse of the Tego connector may reduce the risk of CRBSI and result in lower utilization of thrombolytics, antibiotics, and ESAs, as well as fewer missed dialysis treatments.

Prevention of Bloodstream Infections in Patients Undergoing Hemodialysis

“…The first was a small study in which bloodstream infection rates did not statistically differ between neutral-valve connector with saline lock and standard catheter caps locked with citrate (concentration 46.7%) (48). The second study was a large, retrospective trial that reported a small reduction in the use of intravenous antibiotics with the neutral-valve connector, but no difference in bloodstream infection rates (49).…”

Prevention of catheter-related bloodstream infections in patients on hemodialysis: challenges and management strategies

“…The TEGO needleless connector system (Victus Inc., Miami, FL, USA) was designed to decrease catheter hub manipulation and minimize contamination via the use of a silicone barrier system. 39 Attachment to blood tubing creates a straight, internal fluid path and reinforces a closed system that avoids the need to cap and recap catheter ports. This apparatus was also designed to obviate the need for heparin-locking solution as an anticoagulant.…”

Cluster-Randomized Trial of Devices to Prevent Catheter-Related Bloodstream Infection

“…6 Tego was previously evaluated in a retrospective study, which concluded that Tego may reduce the risk of CRBSI. 7 For additional protection, Curos is used with Tego. Curos kills organisms on the outside surface of Tego using 70% isopropanol alcohol.…”