title: Tunneled dialysis catheter exchange with fibrin sheath disruption is not associated with increased rate of bacteremia.
abstract: OBJECTIVE
  Tunneled dialysis catheters are the most common form of vascular access among incident dialysis patients in the United States. Fibrin sheath formation is a frequent cause of late catheter dysfunction requiring an exchange procedure with balloon disruption of the fibrin sheath. It is unknown whether fibrin sheath disruption is associated with increased incidence of bacteremia or catheter failure.
  
  
  METHODS
  We reviewed all tunneled dialysis catheter exchange procedures at the University of Wisconsin between January 2008 and December 2011. The primary outcome was incidence of bacteremia, defined as positive blood cultures within 2 weeks of the procedure. Catheter failure, requiring intervention or replacement, was examined as a secondary outcome. Baseline characteristics examined included diabetic status, gender, race and age.
  
  
  RESULTS
  A total of 163 procedures were reviewed; 67 (41.1%) had fibrin sheath disruption and 96 did not. Bacteremia occurred in 4.5% (3/67) of those with and 3.1% (3/97) of those without fibrin sheath disruption (p=0.65). Fibrin sheath disruption was not significantly associated with the risk of catheter failure (adjusted hazard ratio [aHR]=1.34; 95% confidence interval [CI]: 0.87-2.10; p=0.18). Diabetes was associated with greater risk of catheter failure (aHR=1.88; 95% CI: 1.19-2.95; p=0.006), whereas higher age was associated with a lower risk of catheter failure (aHR per 10 years=0.83; 95% CI: 0.72-0.96; p=0.01).
  
  
  CONCLUSIONS
  This study demonstrates that there is no significant increase in bacteremia and subsequent catheter dysfunction rates after fibrin sheath disruption compared to simple over the wire exchange. These results are encouraging given the large numbers of patients utilizing tunneled catheters for initial hemodialysis access and the known rates of fibrin sheath formation leading to catheter failure.
authors.affiliation: 1 Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI - USA.
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Valliant
authors.forename: Muhammad K
authors.initials: MK
authors.lastname: Chaudhry
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Yevzlin
authors.forename: Brad
authors.initials: B
authors.lastname: Astor
authors.forename: Micah R
authors.initials: MR
authors.lastname: Chan
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000009:adverse effects; D016470:Bacteremia / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling; D062905:Central Venous Catheters; D020878:Device Removal / Q000009:adverse effects / Q000379:methods*; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D005337:Fibrin; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014922:Wisconsin / Q000453:epidemiology
chemical_list: D005337:Fibrin