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Ruqaya Qureshi, Beena Salman, Salman Imtiaz, Murtaza F Drohlia, Aasim Ahmad
OBJECTIVE: To evaluate the reasons of removal of non-tunneled double lumen catheters (NTDLC) in incident hemodialysis (HD) patients in a tertiary renal care hospital. STUDY DESIGN: Observational retrospective study. PLACE AND DURATION OF STUDY: Department of Nephrology, The Kidney Centre Postgraduate Training Institute (TKC PGTI), Karachi, from June 2015 to May 2016. METHODOLOGY: All patients were selected who had naive NTDLC placement at TKC PGTI either in Emergency Room (ER) or Intensive Care Unit (ICU) during the study period...
April 2018: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Bilal Mohsin
BACKGROUND: Catheter related blood stream infections (CRBSI) are the leading cause of morbidity in HD patients. The majority of these infections relate to haemodialysis catheters. There is a paucity of local data on microbial agents responsible for CRBSI in our region. This prompted our study. METHODS: This Prospective observatory survey was conducted in Department of Nephrology, King Fahd Hospital, Hofuf KSA from Nov 2014 to Jan 2017 (26 months). It was performed on dialysis patients with HD catheters who developed features of CRBSI...
October 2017: Journal of Ayub Medical College, Abbottabad: JAMC
Laura Labriola, Jean-Michel Pochet
The prevention of catheter-related blood stream infections (CRBSI) in hemodialysis (HD) patients remains a challenge because of high morbidity and mortality associated to CRBSI. Alternative locking solutions (ALS) containing an antithrombotic substance with additional antimicrobial or antibiofilm properties (citrate, ethylenediaminetetraacetic acid [EDTA], 70% ethanol, thrombolytics) with or without the addition of molecules with specific antimicrobial activity (antibiotics, taurolidine, paraben-methylene-blue) has been proposed with the aim to prevent or eradicate intraluminal biofilm colonization and subsequent CRBSI...
March 6, 2017: Journal of Vascular Access
Sofia Sofroniadou, Ioanna Revela, Alexandros Kouloubinis, Ioanna Makriniotou, Sinodi Zerbala, Despina Smirloglou, Petros Kalocheretis, Apostolos Drouzas, George Samonis, Christos Iatrou
INTRODUCTION: Ethanol lock solution has been mainly administered in paediatric and home parenteral nutrition patients in order to prevent catheter related blood stream infections (CRBSI). Its utility in hemodialysis (HD) patients with non-tunneled-uncuffed catheter (NTC) has been poorly explored. METHODS: We conducted a prospective randomized study in chronic HD patients requiring a newly inserted NTC-while awaiting for the maturation of an already established arteriovenous fistula (AVF) or arteriovenous graft (AVG) or tunneled-cuffed catheter insertion...
October 2017: Hemodialysis International
Jun Zhang, Bo Wang, Rongke Li, Long Ge, Kee-Hsin Chen, Jinhui Tian
PURPOSE: The purpose of our study is to carry out a Bayesian network meta-analysis comparing the efficacy of different antimicrobial lock solutions (ALS) for prevention of catheter-related infections (CRI) in patients with hemodialysis (HD) and ranking these ALS for practical consideration. METHODS: We searched six electronic databases, earlier relevant meta-analysis and reference lists of included studies for randomized controlled trials (RCTs) that compared ALS for preventing episodes of CRI in patients with HD either head-to-head or against control interventions using non-ALS...
April 2017: International Urology and Nephrology
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
Jun Zhang, Rong-Ke Li, Kee-Hsin Chen, Long Ge, Jin-Hui Tian
INTRODUCTION: Catheter-related infection (CRI) is a difficult clinical problem in renal medicine, with blood stream infections occurring in up to 40% of patients with haemodialysis (HD) catheters, conferring significant rates of morbidity and mortality. Several approaches have been assessed as a means to prevent CRI. Currently, an intervention that is the source of much discussion is the use of antimicrobial lock solutions (ALS). A number of past conventional meta-analyses have compared different ALS with heparin...
January 5, 2016: BMJ Open
Muhammad Kanaa, Mark J Wright, Habib Akbani, Paul Laboi, Sunil Bhandari, Jonathan A T Sandoe
BACKGROUND: Catheter-related bloodstream infections (CRBSIs) cause morbidity and mortality in hemodialysis (HD) patients. Cathasept (tetra-sodium EDTA) solution has antimicrobial and anticoagulant activities. STUDY DESIGN: Multicenter prospective randomized controlled study. SETTING & PARTICIPANTS: 117 maintenance HD patients with confirmed uncolonized tunneled HD catheters from 4 HD centers. INTERVENTION: Patients were randomly assigned to receive Cathasept 4% locks (Cathasept group) or stayed with heparin 5,000 U/mL locks (heparin group), filled thrice weekly according to catheter lumen volume until the catheter was removed or for a maximum of 8 months...
December 2015: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Patricia Brañas, Enrique Morales, Francisco Ríos, Francisca Sanz, Eduardo Gutiérrez, Nuria Quintanilla, M Angeles Orellana, Mercedes Sánchez, Almudena Rodríguez-Aranda, Fernando Chaves
BACKGROUND: To evaluate the use of surveillance cultures (SCs) to prevent catheter-related bloodstream infections (CRBSIs) in asymptomatic hemodialysis (HD) patients. METHODS: In 2011-2012, we conducted a prospective study of HD patients with tunneled cuffed central venous catheters (TCCs). Colonization of the catheter lumen was assessed every 15 days by inoculating ~5 mL endoluminal blood into aerobic culture bottles. Individual patients were triaged based on SC results: group 1 (negative); group 2 (coagulase-negative Staphylococcus [CoNS] with time-to-positivity (TTP) >14 hours); group 3 (CoNS with TTP ≤14 hours); and group 4 (any microorganism other than CoNS and any TTP)...
November 2014: American Journal of Infection Control
Vineet Gupta, Mohamed H Yassin
The incidence of end-stage renal disease (ESRD) has almost doubled over past 2 decades. Despite decreasing overall hospital admission rates for ESRD population, the rate of infection-related hospitalizations has steadily increased. Infection remains the second most common cause of mortality in this patient population. Specifically, in the hemodialysis (HD) patients, the vascular access related infections are the most common identifiable source of infection. This concise review provides an update on the bacteremia related to vascular access primarily the catheters (Catheter Related Blood Stream Infection- CRBSI) in HD patients emphasizing on the determinants ranging from the epidemiology to pathogenesis, risk factors, cost implications and prevention...
June 2013: Infectious Disorders Drug Targets
Jennifer K Broom, Rathika Krishnasamy, Carmel M Hawley, E Geoffrey Playford, David W Johnson
BACKGROUND: Tunnelled central venous dialysis catheter use is significantly limited by the occurrence of catheter-related infections. This randomised controlled trial assessed the efficacy of a 48 hour 70% ethanol lock vs heparin locks in prolonging the time to the first episode of catheter related blood stream infection (CRBSI). METHODS: Patients undergoing haemodialysis (HD) via a tunnelled catheter were randomised 1:1 to once per week ethanol locks (with two heparin locks between other dialysis sessions) vs thrice per week heparin locks...
2012: BMC Nephrology
Anil K Saxena, Bodh R Panhotra, Abdul Aziz Al-hafiz, Dasappan S Sundaram, Bassam Abu-Oyun, Khalifa Al Mulhim
Staphylococcus aureus nasal carriers undergoing hemodialysis (HD) through tunneled cuffed catheters (TCCs) form a high-risk group for the development of catheter-related bloodstream infections (CRBSI) and ensuing morbidity. The efficacy of antibiotic-locks on the outcomes of TCCs among S. aureus nasal carriers has not been studied earlier. Persistent nasal carriage was defined by two or more positive cultures for methicillin-susceptible (MSSA) or methicillin-resistant (MRSA) S. aureus of five standardized nasal swabs taken from all the participants dialyzed at a large out-patient HD center affiliated to a tertiary care hospital...
July 2012: Saudi Journal of Kidney Diseases and Transplantation
Almudena Martín-Peña, Rafael Luque Márquez, M José Marco Guerrero, Nuria Espinosa, Yolanda Blanco, José Ibeas, Ma José Ríos-Villegas, José Miguel Cisneros
PURPOSE: Catheter-related bloodstream infections (CRBSI) are common among patients undergoing long-term hemodialysis (HD) worldwide. The aim of this study was look into the incidence, epidemiology, and risk factors for CRBSI in four medical centers and Spanish dialysis facilities following a common protocol for insertion and management of tunneled hemodialysis catheters (THCs). METHODS: Prospective study including all THCs inserted from September-04 to October-05...
April 2012: Journal of Vascular Access
Nilufer Oguzhan, Cigdem Pala, Murat Hayri Sipahioglu, Havva Cilan, Suleyman Durmaz, Duygu Percin, Aydin Unal, Bulent Tokgoz, Cengiz Utas, Oktay Oymak
OBJECTIVE: Tunneled cuffed dual-lumen catheters (TCCs) are commonly used for vascular access in hemodialysis (HD) patients. Catheter-related bloodstream infection (CRBSI) is the major problem leading to morbidity and mortality. We investigated whether 26% NaCl solution has any favorable effect on the infections and thrombosis caused by HD catheters. METHODS: TCCs were locked with either 26% NaCl and heparin or standard heparin. The primer end point of the study was the CRBSI or thrombosis of the TCC...
2012: Renal Failure
Sofia Sofroniadou, Ioanna Revela, Despina Smirloglou, Ioanna Makriniotou, Sinodi Zerbala, Alexandros Kouloubinis, George Samonis, Christos Iatrou
The use of antibiotic lock solutions (ALSs) for the prevention of catheter-related blood stream infections (CRBSIs) is a promising option. The efficacy and safety of linezolid as ALS were evaluated in a randomized double-blind prospective study where 131 patients who required nontunneled catheter (NTC) for hemodialysis (HD) were randomized to receive an ALS with either (A) unfractionated heparin (2000 U/ml) alone as a catheter lock control, (B) vancomycin (5 mg/ml) + heparin (2000 U/ml), or (C) linezolid (2 mg/ml) + heparin (2000 U/ml)...
May 2012: Seminars in Dialysis
Almudena Rodríguez-Aranda, Jose María Alcazar, Francisca Sanz, Florencio García-Martín, Joaquín R Otero, Jose Maria Aguado, Fernando Chaves
BACKGROUND: Approximately 25% of haemodialysis (HD) patients use catheters as vascular access. Catheter-related bloodstream infections (CRBSI) are a major risk in this population. The objective of our study was to determine whether endoluminal catheter colonization (ECC) predicts CRBSI. METHODS: We followed up a cohort of HD patients in our institution who underwent HD with tunnelled cuffed central venous catheters (TCC) between December 2006 and June 2008. Colonization of the inner catheter lumen was assessed every 15 days immediately before HD by culture of blood-heparin mixture and the time to positivity (TTP) was recorded by the BacT/Alert automated system...
March 2011: Nephrology, Dialysis, Transplantation
Anil K Saxena, B R Panhotra, Abdulrahman S Al-Mulhim
Hemodialysis (HD) patients are at considerably high risk for vascular access-related blood stream infections (VRBSI) that result in serious complications. Such severe infections are a great deal more frequent with central venous catheters (CVCs) and polytetrafluoroethylene (PTFE) grafts than with arteriovenous fistula (AVF). Nonetheless, the CVCs, though having "undesirable" side effects, remain "unavoidable" for the patients requiring instant dialysis access, as a consequence of the unpredictable course of chronic renal disease...
January 2005: Saudi Journal of Kidney Diseases and Transplantation
Anil K Saxena, Bodh R Panhotra, Dasappan S Sundaram, Mohammed Naguib Fahmy Morsy, Ali M Al-Arabi Al-Ghamdi
BACKGROUND: Tunneled-cuffed catheters (TCC) are often used among the elderly to commence and carry out haemodialysis (HD). Complications like infection and thrombosis frequently reduce the lifespan of TCC. The role of an antibiotic heparin 'lock' in the prevention of thrombotic and infectious complications and enhancement of TCC survival in the elderly has not been investigated previously. METHODS: In this prospective, double-blind clinical trial, TCC (n = 119, placed among 113 elderly patients requiring HD during March 2002 - February 2003) were randomised to either group I having TCC (n = 59, placed in 58 elderly patients) locked with cefotaxime (10 mg/mL) and heparin (5000 U/mL), or group II with TCC (n = 60, placed in 55 elderly patients) having catheter-restricted filling of heparin (5000 U/mL) alone...
August 2006: Nephrology
Anil K Saxena, Bodh R Panhotra
BACKGROUND: Reduction in the rates of major complications such as infection and thrombosis that limit the lifespan of hemodialysis (HD) catheters could conceivably lead to improved survival of "temporary" non-tunneled HD catheters (NTCs). This study was designed to evaluate the impact of the "locking"' of a broad-spectrum antibiotic-cefotaxime with heparin, on the incidence of catheter thrombosis, catheter-related bloodstream infections (CRBSI) and the NTC lifespan. METHODS: This prospective study included 208 (109 males and 99 females) end-stage renal disease (ESRD) patients of diverse etiology enrolled for long-term HD from July 2002 to June 2003 at our tertiary care hospital...
November 2005: Journal of Nephrology
Anil K Saxena, Bodh R Panhotra
With the increasing number of elderly, diabetics and debilitated patients being accepted for haemodialysis (HD), the use of central venous catheters (CVCs) as vascular access has become more widespread, with an inevitable inherent risk of catheter-related bloodstream infections (CRBSI) and ensuing mortality. No reliable plans for the effective management of CRBSI without actually sacrificing vascular access sites are presently available. Therefore, the onus really falls on renal physicians to make effective use of the established supportive guiding principles, practices, policies and programs to prevent CRBSI among HD patients...
June 2005: Nephrology
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