Central venous access for haemodialysis: prospective evaluation of possible complications.
OBJECTIVE
The combination of chronic renal insufficiency and haemodialysis represents a challenge for health professionals. Chronic renal insufficiency patients undergoing haemodialysis treatment through a temporary double-lumen catheter were prospectively studied in order to identify the type and frequency of local and systemic complications.


METHODS
A six-month period was established with a view to the inclusion of new cases. Data were acquired through interviews, clinical assessment and patient records, and entered into a Microsoft Excel database through a double entry system and exported to the Statistical Package Social Sciences software. Sixty-four patients were evaluated prospectively, of which thirty-eight (59.4%) were men and 35 (54.7%) required catheter insertion for immediate treatment. During the study period, 145 catheters were inserted, ranging from 1 to 7 implants per patient, 29 (45.3%) were single insertions and 127 (87.6%) catheters were inserted into the jugular vein. The catheters were left in place for an average of 30 days.


RESULTS
Forty-one (64%) presented inadequate functioning, after about 26 days. A febrile state occurred in 24 (37.5%) patients after 34 days, secretion at the catheter entry site in 27 (42.2% after 26 days and bloodstream infection was encountered in 34(53%) after 34 days. Of the 61 blood culture samples, thirty (49%) were positive for Staphylococcus aureus that was the microorganism most frequently isolated.


CONCLUSIONS
The findings indicate worrying aspects such as the catheters permanence time, exposing patients to different complications, including infection. Furthermore, inadequate catheter functioning leads to inefficient haemodialysis treatment.


CONCLUSIONS
Knowledge about complications allows for systematic care planning, prevention and control actions.
de Andrade
Denise
D
University of São Paulo at Ribeirão Preto College of Nursing, WHO Collaborating Centre for Nursing Research Development, Brazil. dandrade@eerp.usp.br
Ferreira
Viviane
V
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000209:etiology; D001938:Brazil / Q000453:epidemiology; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000706:statistics & numerical data; D002408:Catheters, Indwelling / Q000009:adverse effects*; D003428:Cross Infection / Q000209:etiology; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015403:Nursing Evaluation Research; D010146:Pain / Q000209:etiology; D010689:Phlebitis / Q000209:etiology; D011446:Prospective Studies; D011537:Pruritus / Q000209:etiology; D006435:Renal Dialysis / Q000295:instrumentation*; D011795:Surveys and Questionnaires; D013997:Time Factors