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Catheter related infections in hemodialysis patients

Talerngsak Kanjanabuch, Nuttha Lumlertgul, Lachlan J Pearson, Tanittha Chatsuwan, Krit Pongpirul, Asada Leelahavanichkul, Nisa Thongbor, Gunticha Nuntawong, Laksamon Praderm, Pantiwa Wechagama, Surapong Narenpitak, Apinya Wechpradit, Worauma Punya, Guttiga Halue, Phetpailin Naka, Somboon Jeenapongsa, Somchai Eiam-Ong
♦ Background: Melioidosis, an infectious disease caused by Burkholderia pseudomallei, is endemic in Southeast Asia and Northern Australia. Although a wide range of clinical manifestations from this organism are known, peritonitis associated with peritoneal dialysis (PD) has rarely been reported. ♦ Patients and Methods: Peritoneal dialysis patients from all regions in Thailand were eligible for the study if they had peritonitis and either peritoneal fluid or effluent culture positive for B.pseudomallei Patient data obtained included baseline characteristics, laboratory investigations, treatments, and clinical outcomes...
October 13, 2016: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Andrew S Griffin, Shawn M Gage, Jeffrey H Lawson, Charles Y Kim
OBJECTIVE: This study evaluated whether the use of a staged Hemodialysis Reliable Outflow (HeRO; Merit Medical, South Jordan, Utah) implantation strategy incurs increased early infection risk compared with conventional primary HeRO implantation. METHODS: A retrospective review was performed of 192 hemodialysis patients who underwent HeRO graft implantation: 105 patients underwent primary HeRO implantation in the operating room, and 87 underwent a staged implantation where a previously inserted tunneled central venous catheter was used for guidewire access for the venous outflow component...
September 26, 2016: Journal of Vascular Surgery
Aisha Khattak, Ernest I Mandel, Matthew R Reynolds, David M Charytan
BACKGROUND: Percutaneous coronary intervention (PCI) use is low in the setting of stable symptomatic angina in individuals with advanced chronic kidney disease (CKD) despite high cardiovascular risk in this population, and PCI is frequently deferred out of concern for precipitating dialysis therapy. Whether this is appropriate is uncertain, and patient-centered data comparing the relative risks and benefits of continued medical therapy versus PCI in patients with advanced CKD and stable angina are scarce...
September 16, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Jesmar Buttigieg, Angela Borg Cauchi, Marilyn Rogers, Emanuel Farrugia, Stephen Fava
Seasonal variation in the incidence of peritoneal dialysis-related infections (PDRI) has been sparingly investigated, especially in the Mediterranean. Our aim was to explore this association in Malta. All PDRI occurring between Jan-2008 and Dec-2012 were retrospectively studied.A total of 137 patients were followed-up for a median time of 32.5 months (range: 2-81). During this time, 19% never had PDRI, 11.7% transferred permanently to hemodialysis and 6.6% received a kidney transplant. A total of 279 PDRI were identified, equating to 145 catheter-related infections (CRI) and 144 peritonitis episodes (including 10 catheter related peritonitis)...
October 2016: Therapeutic Apheresis and Dialysis
Franklin Correa Barcellos, Bruno Pereira Nunes, Luciana Jorge Valle, Thiago Lopes, Bianca Orlando, Cintia Scherer, Marcia Nunes, Gabriela Araújo Duarte, Maristela Böhlke
BACKGROUND: Central venous catheters (CVC) are the only option when hemodialysis is needed for patients without definitive vascular access. However, CVC is associated with complications, such as infection, thrombosis, and dysfunction, leading to higher mortality and expenditures. The aim of this study was to compare the effectiveness of 30 % trisodium citrate (TSC30 %) with heparin as CVC lock solutions in preventing catheter-related bloodstream infections (CRBSI) and dysfunction in hemodialysis patients...
August 29, 2016: Infection
Marco Righetti, Nicola Palmieri, Oscar Bracchi, Mario Prencipe, Elena Bruschetta, Francesca Colombo, Irene Brenna, Francesca Stefani, Karen Amar, Alfio Scalia, Ferruccio Conte
INTRODUCTION: Catheter-related infections are an important clinical problem in maintenance hemodialysis patients. Catheter-related bloodstream infections have a negative effect on survival, hospitalization and cost of care. Tegaderm™ chlorhexidine gluconate (CHG) dressing may be useful to reduce catheter-related infection rates. METHODS: We performed a study to assess the efficacy of Tegaderm™ CHG dressing for reducing catheter-related infections. We designed a prospective randomized cross-over study with a scheme of two treatments, Tegaderm™ CHG dressing versus standard dressing, and two periods of six months...
August 1, 2016: Journal of Vascular Access
Farida Sahli, Razika Feidjel, Rima Laalaoui
The main complication of central venous catheter (CVC) in hemodialysis is infection. Identifying CVC related infection (CVC-RI) risk factors and causative micro-organisms is important for setting prevention policies. There were no data regarding CVC-RI in hemodialysis in Algeria. To determine rates of CVC-RI in hemodialysis in Setif university hospital, risk factors and causative microorganisms, we conducted a prospective study from November 2014 to May 2015 involving patients with CVC in hemodialysis. Micro-organisms isolated from semi quantitative culture of CVC and blood culture were identified and tested for antibiotic susceptibility using the automated MicroScan system (DADE Behring, Sacramento, CA, USA)...
July 13, 2016: Journal of Infection and Public Health
Samer A Naffouje, Ivo Tzvetanov, James T Bui, Ron Gaba, Karrel Bernardo, Hoonbae Jeon
BACKGROUND: Hemodialysis Reliable Outflow (HeRO) catheters were introduced in 2008, and have been since providing a reliable alternative for hemodialysis patients who are deemed "access challenged." However, its outcomes have not been extensively investigated due to its relatively young age. Here, we report our 6-year single institution experience, and demonstrate the significant impact of obesity on HeRO graft outcomes, an aspect not previously studied in the literature. METHODS: Patients who underwent HeRO graft placement at the University of Illinois Hospital between 04/2009 and 08/2015 were included retrospectively...
July 12, 2016: Annals of Vascular Surgery
Gregor Novljan, Rina R Rus, Vladimir Premru, Rafael Ponikvar, Nina Battelino
When peritoneal dialysis is inapplicable, chronic hemodialysis (HD) becomes the only available treatment option in small children. Due to small patient size, central venous catheters (CVC) are mainly used for vascular access. Over the past 4 years, four children weighing less than 15 kg received chronic HD in our unit. A total of 848 dialysis sessions were performed. Altogether, 21 catheters were inserted. In all but one occasion, uncuffed catheters were used. Catheter revision was performed 15 times during the study period, either due to infection or catheter malfunction...
June 2016: Therapeutic Apheresis and Dialysis
Jakob Gubensek, Matej Zrimsek, Vladimir Premru, Jadranka Buturovic-Ponikvar, Rafael Ponikvar
The choice of vascular access in very elderly hemodialysis patients can be complex. Data on the frequency of interventions and complications when temporary catheters are used for long periods in this population are lacking. All incident patients ≥80 years old, dialyzed over non-tunneled catheters, were included and the frequency of interventions (re-insertions and wire-exchanges) and complications (catheter-related blood stream infections) were recorded. In 31 patients aged 84 ± 4 years, dialyzed for 1...
June 2016: Therapeutic Apheresis and Dialysis
Sarah D Kosa, Cynthia Bhola, Charmaine E Lok
PURPOSE: To understand the patient's perspective on complications associated with vascular access-related interventions. METHODS: A multi-stage comprehensive questionnaire of over 150 items was administered to 140 in-center hemodialysis patients in a large, Toronto-based academic-based facility from May 1, 2011 until July 1, 2014. The questionnaire was divided into three domains: physical complications, disruption to routine, and infection. For each of the 12 prespecified vascular access interventions, there were 9 items about the associated complications...
July 12, 2016: Journal of Vascular Access
Deborah M Stupak, Jennifer A Trubilla, Susann R Groller
In an attempt to create a standardized resource for cleansing both non-tunneled and tunneled hemodialysis catheters, it was discovered that all disinfectants are not compatible with all catheters. This article describes the process used to identify best practices for hemodialysis catheter care and steps taken to standardize practice throughout a hospital network. Standardized evidence-based practice preserves the integrity of catheters while allowing nurses to provide quality care to patients.
March 2016: Nephrology Nursing Journal: Journal of the American Nephrology Nurses' Association
Kristina K Davis, Kathleen G Harris, Vrinda Mahishi, Edward G Bartholomew, Kevin Kenward
Staff members, physicians, nurse practitioners, and physician assistants from a sample of hemodialysis facilities in Network 6 (North Carolina, South Carolina, and Georgia) and Network 11 (Michigan, Minnesota, North Dakota, South Dakota, and Wisconsin) completed a 10-item assessment with modified questions from the Hospital Survey on Patient Safety Culture, with an emphasis on safety culture related to vascular access infections. A composite score was constructed, which was the average of the percent-positive scores of the items...
March 2016: Nephrology Nursing Journal: Journal of the American Nephrology Nurses' Association
Xin Han, Xiaoli Yang, Bihong Huang, Li Yuan, Yanpei Cao
BACKGROUND: Low-dose heparin lock has been suggested as an effective and safe catheter lock in hemodialysis. However, whether a low-dose lock is superior to a high-dose heparin lock in preventing catheter-related infections and maintaining catheter patency is inconclusive. STUDY DESIGN: A systematic review and meta-analysis was performed by searching in NGC (National Guideline Clearinghouse), Cochrane Library, Joanna Briggs Institute Library, MEDLINE, EMbase, RNAO (Registered Nurses' Association of Ontario), Nursing Consult, PubMed, OVID, China Biology Medicine disc (CBMdisc), China National Knowledge Infrastructure (CNKI), Chongqing VIP (CQVIP), Wanfang Data Knowledge Service Platform, and major nephrology journals...
July 2016: Clinical Nephrology
Vivek Soi, Carol L Moore, Lalathakasha Kumbar, Jerry Yee
Catheter-related bloodstream infections are a significant source of morbidity and mortality in the end-stage renal disease population. Although alternative accesses to undergoing renal replacement therapy exist, many patients begin hemodialysis with a dialysis catheter due to logistic and physiologic factors involved in arteriovenous fistula creation and maturation. Colonization of catheters via skin flora leads to the production of biofilm, which acts as a reservoir for virulent bacteria. Preventative therapies center on appropriate catheter maintenance, infection control measures, and early removal of devices as patients transition to other access...
2016: International Journal of Nephrology and Renovascular Disease
Michael Allon
Once hemodialysis patients have exhausted all option for a permanent vascular access in both upper extremities, they are often relegated at many dialysis centers to permanent catheter dependence with all its attendant complications, including infections, frequent dysfunction, and central vein stenosis. This commentary makes the case that thigh grafts are a far superior alternative to dialysis catheters in many of these patients. Technical graft failure may occur in some patients due to severe femoral artery calcification, but screening for calcification by ultrasound or computerized tomography can reduce the likelihood of a technical failure...
July 2016: Seminars in Dialysis
Friederike Quittnat Pelletier, Mohammad Joarder, Susan M Poutanen, Charmaine E Lok
BACKGROUND AND OBJECTIVES: Guideline-recommended diagnostic criteria for hemodialysis (HD) catheter-related bloodstream infections (CRBSIs) are based on data from indwelling central catheters in patients not on HD and non-HD situations, and upon which peripheral vein cultures are the gold standard. We aimed to examine the validity of these criteria in patients on HD. DESIGN, SETTINGS, PARTICIPANTS, & MEASUREMENTS: Adult patients on in-center HD using catheters were prospectively followed from 2011 to 2014 at a large academic-based HD facility (Toronto, Canada)...
May 6, 2016: Clinical Journal of the American Society of Nephrology: CJASN
Peter R Bream
Central venous catheters are a popular choice for the initiation of hemodialysis or for bridging between different types of access. Despite this, they have many drawbacks including a high morbidity from thrombosis and infection. Advances in technology have allowed placement of these lines relatively safely, and national guidelines have been established to help prevent complications. There is an established algorithm for location and technique for placement that minimizes harm to the patient; however, there are significant short- and long-term complications that proceduralists who place catheters should be able to recognize and manage...
March 2016: Seminars in Interventional Radiology
Maurizio Gallieni, Antonino Giordano, Umberto Rossi, Maurizio Cariati
Central venous catheters (CVCs) are essential in the management of hemodialysis patients, but they also carry unintended negative consequences and in particular thrombosis and infection, adversely affecting patient morbidity and mortality. This review will focus on the etiology, prevention, and management of CVC-related dysfunction, which is mainly associated with inadequate blood flow. CVC dysfunction is a major cause of inadequate depuration. Thrombus, intraluminal and extrinsic, as well as fibrous connective tissue sheath (traditionally indicated as fibrin sheath) formation play a central role in establishing CVC dysfunction...
March 2016: Journal of Vascular Access
Mariana Murea, Scott Satko
Vascular access preparation, a pervasive challenge in hemodialysis (HD), is emerging as a multidimensional subject in geriatric nephrology. Previously published guidelines declared arteriovenous fistulas (AVF) as the preferred vascular access for all patients on HD. In this article, the benefit-risk evidence for using AVF versus an alternative access (arteriovenous graft [AVG] or tunneled central venous catheter [TCVC]) in the elderly is pondered. Compared to their younger counterparts, the elderly have significantly lower survival rates independent of the vascular access used for HD...
September 2016: Seminars in Dialysis
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