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Kidney Week

Abstract: PO1351

A Retrospective Study of Tunneled Dialysis Catheters with Exposed Cuff and Risk of Subsequent Catheter-Related Bloodstream Infection

Session Information

  • Vascular Access
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Bauer, Zachary J., Henry Ford Hospital, Detroit, Michigan, United States
  • Hana, Aeman, Henry Ford Hospital, Detroit, Michigan, United States
  • Kassab, Christopher, Henry Ford Hospital, Detroit, Michigan, United States
  • Rajagopal, Amulya, Henry Ford Hospital, Detroit, Michigan, United States
  • Kumbar, Lalathaksha Murthy, Henry Ford Hospital, Detroit, Michigan, United States
Background

Tunneled dialysis catheters (TDC) are prevalent in patients with end stage renal disease (ESRD) on hemodialysis (HD). Exposure of catheter cuff leads to replacement of TDC over guidewire (TDCEx). It is unclear if exposed catheter cuff increases the risk of infection if exchanged over guidewire.

Methods

This single center retrospective study reviewed TDCEx procedures in patients with ESRD on HD using a TDC for at least 14 days.The primary endpoint was catheter related bloodstream infections within 30 days or within 90 days of catheter exchange. Infection rate (IR) were reported as total infections per 1000 catheter days.

Results

1030 procedures were reviewed; 537 were included. TDCEx for mechanical dysfunction (n=305) and exposed cuff (n=130) were compared to TDC with infection (n=102). Catheters with infection were mainly treated with removal and delayed insertion. IR based on indications were, 0.78 (95% confidence interval (CI), 0.38-1.38) for infections, 0.64 (95% CI, 0.24-1.14) for exposed cuffs, 0.46 (95% CI, 0.25-0.76) for mechanical dysfunction. When comparing all TDCEx due to non-infectious reason to the catheters with infection, no significant difference was found for IR within 30 days [hazard ratio (HR), 0.78; 95% confidence interval (CI), 0.21-2.82; p-value 0.700] or within 90 days (HR, 0.51; 95% CI, 0.24-1.07; P=0.075). Comparing TDCEx due to exposed cuff with TDCEx for a mechanical dysfunction, insignificant difference in IR was noted at 30 days [HR, 1.59; 95% CI, 0.45-5.63; P=0.474] and at 90 days (HR, 1.65; 95% CI, 0.71-3.87; P=0.246). No significant difference was seen in IR between catheters with infection and TDCEx for exposed cuffs at 30 days [HR, 0.95; 95% CI, 0.21-4.25; P=0.948] or at 90 days (HR, 1.42; 95% CI, 0.58-3.51; P=0.442). Catheters with infection compared to TDCEx for mechanical dysfunction had a significantly increased IR at 90 (HR, 2.36; 95% CI, 1.03-5.37; P=0.042) with no significant difference at 30 days [HR, 1.52; 95% CI, 0.38-6.06; P=0.556].

Conclusion

TDCEx for catheters with exposed cuff do not increase the risk for catheter related bloodstream infections at 30 or 90 days. Infected catheters continue to have a higher risk for CRBSI at 90 days even with removal and delayed insertion.