title: Inserting tunnelled hemodialysis catheters using elective guidewire exchange from nontunnelled catheters: is there a greater risk of infection when compared with new-site replacement?
abstract: The objective is to evaluate bacteremia outcomes and survival rates when using guidewire exchange to place tunnelled hemodialysis catheter (THDC) compared with a new-site replacement. Retrospectively, all patients were identified who received a THDC between January 1, 2000 and January 1, 2007. Any THDC having received antibiotic line locks or tunnel-to-tunnel exchange were excluded. This left 408 THDC placed in 329 patients: 46 guidewire exchange, 362 new-site replacement. Bacteremia rate from the new-site insertion group was 3.0 per 1000 catheter days, the guidewire exchange group demonstrated a rate of 2.8 per 1000 catheter days. Local infection rates did not differ between the groups at 1.2 per 1000 catheters days. The actuarial catheter survival rates using Kaplan-Meier survival analysis demonstrated no difference between the 2 groups. The placing of tunnelled cuffed hemodialysis catheters to replace temporary catheters using a guidewire exchange did not contribute to further episodes of sepsis and has the advantage of preserving venous access and minimizing invasive procedures for the patient.
authors.affiliation: Department of Nephrology, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, Merseyside, UK. jonathan.casey@whnt.nhs.uk
authors.forename: Jonathan
authors.initials: J
authors.lastname: Casey
authors.forename: Jonathan
authors.initials: J
authors.lastname: Davies
authors.forename: Amanda
authors.initials: A
authors.lastname: Balshaw-Greer
authors.forename: Nichola
authors.initials: N
authors.lastname: Taylor
authors.forename: Alexander V
authors.initials: AV
authors.lastname: Crowe
authors.forename: Peter
authors.initials: P
authors.lastname: McClelland
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology* / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D006801:Humans; D007239:Infections / Q000453:epidemiology*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents