Nephrology Dialysis Transplantation, Vol 14, Issue 7 1710-1714, Copyright © 1999 by Oxford University Press
L Kairaitis and T Gottlieb
Background: The use of temporary haemodialysis
catheters is often complicated by mechanical or infectious complications.
Risk factors for these complications and optimal management to reduce their
incidence are largely unknown. Methods: We conducted a
prospective study of 105 haemodialyis catheters (79 subclavian, 26 jugular)
inserted in 52 patients in order to identify patients outcomes and to
analyse the effect of patients and catheter factors on the incidence of
infectious complications by multivariate analysis.
Results: Fifty-nine per cent of catheters were removed
for a suspected complication. Catheter-related bacteraemia (CRB) was
diagnosed in 17 catheters (16%), giving a bacteraemia rate of 6.5 episodes
per 1000 catheter days. Subgroup analysis revealed a higher risk of CRB
with the use of the internal jugular compared with the subclavian site
(hazard ratio 3.97, P=0.02). Age, diabetes or catheter exchange over a
guidewire did not alter the risk of CRB. The cumulative risk of developing
CRB increased in a linear fashion as the period of catheterization
increased. Exit-site infection was the cause for removal in eight catheters
(8%). Although the number of exit-site infections was small, the risk of
exit-site infection was increased in diabetic patients (hazard ratio 10,
P=0.03) and the jugular position (hazard ratio 6.5, P=0.01) but not by age
or catheter exchange over a guidewire. Staphylococcus
aureus and coagulase-negative staphylococcus accounted for all
proven episodes of CRB. Exit-site infection was associated with a mixture
of Gram-positive and Gam-negative organisms.
Conclusion: Temporary haemodialysis catheters have a
high failure rate associated with a significant rate of complications. Use
of the internal jugular site is associated with a significantly higher risk
of infectious complications and methods to reduce this risk should be
considered if this site is used. Key words: catheter;
complication; haemodialysis; infection; jugular; subclavian
ORIGINAL ARTICLES
Outcome and complications of temporary haemodialysis catheters
Department of Renal Medicine and Department of Infectious Diseases and Microbiology, Concord Repatriation General Hospital, Concord, NSW, Sydney, Australia; Corresponding author at: 15 Scott Street, Five Dock, NSW 2046, Sydney, Australia
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