[An efficient strategy to decrease the central venous catheter-related adverse events rate in haemodialysis patients].
BACKGROUND
Catheter-related adverse events (CAE) remain a major cause of mortality and morbidity.


OBJECTIVE
We aimed to compare the CAE prevalence and adverse events rate at 10 years interval in one centre using different devices, dressing procedures.


METHODS
We compared two periods, from 1994 to 1997 (period 1) and from 2004 to 2007 (period 2). We recorded all prevalent tunnelled CAE and their related adverse event rate: catheter-related bacteraemia (CRB), catheter local infection (CLI), catheter dysfunction leading to CAE exchange, thrombolytic use and spontaneous pulling up.


RESULTS
In period 1, PermCath catheter (Quinton, N=63) and TwinCath catheter (MedComp, N=76) were used in 95 HD. BioFlex catheter (N=52) and ASPC split catheter (MedComp, N=52) were used in 72 HD in period 2. In period 1, we performed catheter dressing using povidone iodine versus alcoholic chlorexidine in period 2. Between period 1 and period 2, the CAE prevalence decreased from 15-18% to 9-6%, CRB from 1.1 to 0.23/1000 day-catheter (p<0.001), CLI from 1.1 to 0.28/1000 day-catheter (p<0.001), definitive dysfunction from 12 to 1.2% (p<0.001) and CAE pulling up from 4 to 0%. The annual urokinase consumption decreased from three to one unit per CAE.


CONCLUSIONS
This study shows the dramatic decrease in CAE prevalence (-50%) and related-adverse events (approximately -200%) since 10 years. Switching povidone iodine to chlorexidine and using more recent catheter devices appear very efficient in decreasing catheter-related adverse events.
Jean
Guillaume
G
Centre de rein artificiel, 42, avenue du 8-Mai-1945, 69160 Tassin-La-Demi-Lune, France. guillaume-jean-crat@wanadoo.fr
Vanel
Thierry
T
Bresson
Eric
E
Terrat
Jean-Claude
JC
Hurot
Jean-Marc
JM
Lorriaux
Christie
C
Mayor
Brice
B
Chazot
Charles
C
D000368:Aged; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects; D004866:Equipment Contamination / Q000517:prevention & control; D005260:Female; D006801:Humans; D007239:Infections / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects* / Q000295:instrumentation*; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods / Q000706:statistics & numerical data