HAEMODIALYSIS

HAEMODIALYSIS CATHETER RELATED INFECTIONS

Abstract

Introduction: Vascular access is lifeline for haemodialysis (HD) patients.
Catheter related infections limit the duration of such devices and are important cause of
morbidity in this population the main complication of catheter in hemodialysis is infection.
Objectives: To determine frequency of haemodialysis Catheter Related Infections in
haemodialysis patients. Study Design: Prospective study. Place and Duration: This study
was conducted at Department of Nephrology, King Abdul Aziz Specialists Hospital, Taif, Saudi
Arabia in 1 year from Jan to Dec 2017. Methodology: This study included one hundred sixteen
adults who underwent catheterization for Haemodialysis. These patients were evaluated to
determine the incidence of catheter related infections. At each dialysis session patients were
clinically examined and cultures taken from exit site and blood. Ten malfunctioning catheters
were changed over guide wire. At the time of catheter removal or change catheter tips were
sent for culture. Results: Total of 116 catheters (50 femoral, 52 jugular, 14 subclavian) were
evaluated. Duration of catheterization varied from 2-70 days (average 21 days) for jugular and
subclavian whereas for femoral catheters it was 1-30 days (mean 8.4 days). Exit site cultures
were positive in 76 (66%) patients and common organism were Staphylococcus epidermis 32,
Staphylococcus aureus 24, Gram negative rods in 12 and mix growth in 08 patients. Clinical
sepsis was observed in 27(23%) patients (fever with /without chills, purulent discharge around
catheter. One patient had endocarditis with big mass in right atrium). Organism isolated from
these patients were (Staphylococcus aureus 11, Staphylococcus epidermis 8, gram negative
5). Bacteremia alone was observed in 13 (11%) patients. Of 10 patients with soaked dressing
7 (70%) patients subsequently became febrile. In all these patients catheters were removed
and antibiotics instituted. Although clinical sepsis was more with jugular than femoral catheters
but could be related to longer duration of jugular catheters. Catheters removed from febrile
patients had much higher rate of colonization and bacteremia. Catheter exchange over guide
wire was not associated with higher infection rates. Conclusions: Catheter related infection still
remain high in dialysis population. Staphylococcus epidermis and Staphylococcus aureus were
commonly isolated organisms. Cather sepsis was an important cause of morbidity in these
patients. Long duration of catheterization, soaked dressing and colonization were important
risk factors.