Análisis de los factores que influyen en la aparición de complicaciones y supervivencia de los catéteres venosos centrales para hemodiálisis

Abstract

One of the main nephrology nursing activities in haemodialysis units is the care of central venous catheters by complying with a protocol that places particular emphasis on universal aseptic measures during handling. There are also other variables that can affect the appearance of complications in the catheter, limiting its survival. Objective: The objectives of this study were to analyse the factors that can influence the appearance of complications of the central venous catheter for haemodialysis, and evaluate the infection rates in our centre. Material and method: A descriptive study was carried out of a cohort in the Dialysis Unit of Hospital Meixoeiro, between January 1991 and October 2012, with a sample made up of 1231 catheters. Results: 1231 catheters were implanted (1187 temporary catheters and 44 Hickman-type tunnelled catheters). Tempo rary: 78% in femoral, 18% in jugular, and 4 % in subclavian vein. Hickmam: 40 on the right side, and 4 on the left side. The average duration of the implanted catheters was 17.7 ± 30.8 days (median 8 days). 88% did not present incidents during placement. The main causes for placing catheters were IRA (56%) and failure of previous vascular access (30%). The main complication in the causes for removal was obstruction of the catheter (15%), while the most serious complication was infection (6%). Of the 1231 catheters, 70 presented an episode of infection after 19.1±33.0 days on average, (median of 12 days). Infection rate (2010-2012) of 0.75/1000 catheter days. Conclusion: We conclude that the application of continuous standardized care according to a protocol that places special emphasis on asepsis during connection and disconnection of the CVC results in a low infection rate in this unit.