A Retrospective Study of Catheter-Related Bloodstream Infection Risk after Exchanging Tunneled Dialysis Catheters in Patients with End-Stage Renal Disease - Abstract
Background: Tunneled dialysis catheters (TDC) are used for hemodialysis in patients with acute kidney injury or end-stage renal disease who do not have functioning arteriovenous fistulas or grafts. Sometimes, TDCs must be exchanged because of mechanical flow limitations, infection, or catheter cuff exposure. TDC can either be removed with delayed reinsertion or exchanged over a guidewire. Currently, the risk of downstream infection associated with TDC exchange with a guidewire is unclear. Methods: This single-center, retrospective study assessed patients with end-stage renal disease who had a hemodialysis TDC replacement between January 2015 and December 2019. We analyzed the association of the type of inciting event for TDC replacement (infection, exposed cuff, and flow dysfunction) and mode of TDC replacement (removal with delayed reinsertion versus guidewire exchange) with bloodstream infection at 30 and 90 days after exchange.Results: Of 537 patients who had a TDC replacement, 435 underwent guidewire exchange: 305 (57%) for flow dysfunction and 130 (24%) for exposed cuff. One hundred two (19%) patients underwent catheter removal with delayed reinsertion for presence of infection. TDC exchange with removal and delayed insertion performed because of existing infection was associated with higher risk of subsequent infection than guidewire exchanges performed due to flow dysfunction (hazard ratio 2.36; 95% CI, 1.03-5.37; P = 0.042). No significant differences in infection at 30 and 90 days were seen in patients who underwent guidewire exchange for exposed cuff or mechanical dysfunction. Conclusions: Exchanging TDCs because of exposed cuff or flow dysfunction via a guidewire may not increase the risk of bloodstream infection. However, patients with bloodstream infections who have TDCs removed and reinserted at a different site after infection clearance may still be at increased risk of
subsequent catheter-related infection