SUSPECTED CATHETER-RELATED BLOODSTREAM INFECTION - NONTUNNELED VS TUNNELED HEMODIALYSIS CATHETERS

Objectives: Complication of central venous catheterization for hemodialysis are catheter thrombosis and catheter-related bloodstream infection (CRBI). We report rates of bacteremia experienced with all types of central venous catheters (CVC). We used femoral and subclavian catheters as non-tunneled CVC (NTCVC) and tunneled CVC (TCVC)-femoral, subclavian and jugular catheters. Methods: In a prospective study we looked at the outcome of a group of 620 patients (pts) with acute and chronic renal failure treating with hemodialysis via a 738 CVC, during a 3-year period. Catheters were placed by nephrologists in a femoral, internal jugular and subclavian vein, and episodes of catheter infection were recorded. Each catheter was followed individually until it was removed or until the end of the study. Results: In total, 539/738 (74.9%) of procedures were insertions of NTCVC, whilst 181/738 (25.1%), were insertions of TCVC. Of the NTCVC insertion, 501/738 (69.6%) were inserted into femoral vein, with 38/738 (5.3%) in subclavian vein. In a group of TCVC - 103 were tunneled femoral (56.9%), 41 - tunnelled jugular (22.6%) and 37 subclavian (20.5%) catheters. A total of 44 576 catheter days were accumulated over the study period during which time were 42 cases of CRBI (infective rate 2.57 episodes/1000 catheter days). Rates of CRBI were 2.77 episodes/1000 cath. days in the TCVC group; 3.5 per 1000 cath days in NTCVC. Multivariant analysis demonstrated hazard ratios (HR) for the development of CRBI in pts dialysing with subclavian NTCVCs of 2.9 [95% confidence interval (CI) 1.5-4.8, p