SP631HEMODIALYSIS TUNNELED CENTRAL VENOUS CATHETERS: FIVE YEARS SINGLE CENTER EXPERIENCE

Abstract

Introduction and Aims: Central venous catheters used for hemodialysis are a common cause of complications. Catheter malfunction secondary to thrombosis or malposition of the catheter, and catheter-related bloodstream infections (CRBI) are common occurences. Methods: We looked at the outcome of a group of 170 patients ( pts) receiving chronic HD treatment via a tunneled-cuffed catheters during the 5-year period. Criteria for catheter removal were (1) persistant bloodstream infection (2) catheter dysfunction. Event rates were calculated per 1,000 catheter days, and Kaplan Meier analysis was estimated for THC cumulative survival Results: 262 THC were included in the analysis and were grouped by insertion site of the catheter : (TFC) n=135; (TJC) n= 59, (TSC) n=68. Duration time of THC, average 129-429 days (median -TFC=149, TJC=310 TSC=365). Mostly of THC were removed because of malfunction 44% of TFC, 47% of TJC and 60% of TSC. Infection rate were: TFC - 0,64 episodes/1000 catheter days; TJC - 0,45 and TSC -0,19. 27 catheters had 56 episodes of CRBI and they were successfully treated with antibiotics (systemically and antibiotic “lock” therapy) without the need for catheter removal. The most common isolated microorganisms were Gram-positive. Antibiotic therapy was statistically significant for catheters survival in group with TSC. Risk factors were most likely to result in colonization or infection with multiresistant species: advanced age (odds ratio [OR], 1,2 to 14.1); prolonged hospital stay (OR, 1,3 to 17,5); and exposure to broad-spectrum antimicrobial drugs (OR, 1,6 to 25,1). Statistically significant difference was found between the groups in terms of previously placed catheters ( p =0,000), and the number of previously thrombosed AVF (p=0,0017∗) Conclusions: Our data showed an high survival rate of THC in pts undergoing HD, with low incidence of CRBI. Tunneled femoral catheters have shorter duration time compared to jugular and subclavian catheters but they can be an option for hemodialysis, because the percentage of complications in this group was not high, and sometimes they are placed in pts whom other VA modalities were unavailable or failed . Careful application of standard protocols and well educated dialysis staff contributed to achive this results.