title: Hemodialysis tunneled central venous catheters: five-year outcome analysis.
abstract: BACKGROUND
  Tunneled central venous catheters (tCVCs) are considered inferior to arteriovenous fistulas (AVFs) and grafts in all nephrology guidelines. However, they are being increasingly used as hemodialysis vascular access. The purpose of this study was to document the natural history of tCVCs and determine the rate and type of catheter replacement.
  
  
  METHODS
  This was a prospective study of 141 patients who underwent hemodialysis with tCVCs between January 2008 and December 2012. The patients used 154 tCVCs. Standard protocols about management of tCVCs, according to European Renal Best Practice, were well established. All catheters were inserted in the internal jugular vein. Criteria for catheter removal were persistent bloodstream infection, detection of an outbreak of catheter-related bloodstream (CRBS) infections, or catheter dysfunction. Event rates were calculated per 1,000 catheter days; tCVC cumulative survival was estimated by Kaplan-Meier analysis.
  
  
  RESULTS
  Catheter replacement occurred in 15 patients (0.29 per 1,000 days); catheter dysfunction was the main cause of replacement (0.18 per 1,000 days), typically within 12 months of surgical insertion. A total of 53 CRBS events in 36 patients were identified (0.82 per 1,000 days); 17 organisms, most commonly Gram-positive pathogens, were isolated; 87% of CVC infections were treated by systemic antibiotics associated with lock therapy. tCVC cumulative survival was 91% at 1 year, 88% at 2 years and 85% at 4 years.
  
  
  CONCLUSIONS
  Our data show a high survival rate of tCVCs in hemodialysis patients, with low incidence of catheter dysfunction and CRBS events. These data justify tCVC use for hemodialysis vascular access, also as first choice, especially in patients with exhausted peripheral access and limited life expectancy.
authors.affiliation: 1 Renal Unit, Ospedale Maggiore, Lodi - Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Mandolfo
authors.forename: Pasqualina
authors.initials: P
authors.lastname: Acconcia
authors.forename: Raffaella
authors.initials: R
authors.lastname: Bucci
authors.forename: Bruno
authors.initials: B
authors.lastname: Corradi
authors.forename: Marco
authors.initials: M
authors.lastname: Farina
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Rizzo
authors.forename: Andrea
authors.initials: A
authors.lastname: Stucchi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D055499:Catheter-Related Infections / Q000382:microbiology / Q000628:therapy; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D062905:Central Venous Catheters; D020878:Device Removal; D018572:Disease-Free Survival; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007558:Italy; D007601:Jugular Veins; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents