Risk factors for staphylococcal bacteremia in patients undergoing hemodialysis using dual lumen catheters / 대한내과학회지

BACKGROUND/AIMS: Risk factors for infection in patients undergoing hemodialysis during dual lumen catheterization have not been adequately defined. We investigated risk factors associated with Staphylococcal bacteremia (SB) in patients undergoing hemodialysis using a catheter. METHODS: Patients undergoing hemodialysis with a catheter were categorized into either the SB group (n=43) or control group (n=44). Data on patient demographics, the presence of underlying diseases, antibiotic use, APACHE II scores, and laboratory findings were collected retrospectively. RESULTS: Patients in the SB group tended to be older, and underwent dialysis upon admission more frequently, as compared with controls. In addition, the SB group had higher APACHE II scores, BUN, and lower creatinine levels upon admission, as compared with the control group. A multivariate analysis showed that dialysis upon admission was a risk factor for SB in patients undergoing hemodialysis using a catheter. Patients with Staphylococcus aureus bacteremia (SAB) also tended to be older and showed a higher incidence of both dialysis upon admission and antibiotic therapy prior to catheterization, as compared with the control group. Patients with SAB also had higher APACHE II scores, BUN and creatinine levels upon admission. Antibiotics prior to catheterization, higher creatinine levels, and dialysis upon admission were all independent risk factors for SAB. Patients with methicillin-resistant SB had lower albumin and creatinine levels than those with methicillin-susceptible SB. The incidences of catheterization in the general ward or ICU and antibiotic therapy prior to catheterization were both higher in the methicillin-resistant SB group. Catheterizations in the general ward or ICU and antibiotic therapy prior to catheterization were both independent risk factors for methicillin-resistant SB. CONCLUSIONS: In patients undergoing hemodialysis with a catheter, dialysis upon admission was an independent risk factor for SB. Additionally, antibiotic therapy prior to dual lumen catheterization was a risk factor for methicillin-resistant SB.

Complications of Dual Lumen Catheter for Hemodialysis Patients

INTRODUCTION: Central venous catheterization by dual lumen catheter (DLC, Perm Cath ) is used for temporary or permanent vascular access. Although it has many advantages such as rapid insertion, emergent usage or long-term maintenance, there are still clinically important complications associated with insertion procedure and maintaining period. PURPOSE: To define and manage the various kinds of complications is important to avoid repetition of them and to guide for selection of vascular access in long-term hemodialysis patients. MATERIALS AND METHODS: Between May 1993 and April 1996, we experienced 95 cases of DLC in 88 uremic patients for the following reasons: 12 cases in 12 patients for ARF and 83 cases in 76 patients for ESRD. We used external or internal jugular veins and the method of insertion was percutaneous venipuncture in internal jugular vein (88 cases, Rt.=84, Lt.=4) and venotomy in external jugular vein (7 cases Rt=7). The complications and their therapeutic options were analyzed retrospectively. RESULTS: Group I complication is associated with insertion procedure, including cardiac arrhythmia (n=65, 68.4%), minor air embolism (n=3, 3.2%), hematoma on puncture site (n=15, 15.8%) and difficult catheterization on multipunctured patients (n=3, 3.2%). Group II complication is associated with long term maintanence use of catheters(mean period=8.3 mos) and includes catheter thrombosis (n=15, 15.8%), inadvertent cuff exposure (n=10, 10.5%) and bacteremia (n=16, 16.6%). The management of complications were as followings. Cardiac arrhythmia occurred during guidewire insertion was completely resolved with wire retraction and clinically detected minor air embolism was recovered spontaneously in all cases. Hematoma on puncture site was controlled by compression in 13 cases and 2 cases were resolved after catheter removal. All of the difficult catheterization was solved with fluoroscopic guide insertion. Most of catheter thrombosis were controlled with urokinase infusion (n=13), but in 2 cases, catheter removal was required. All cases of inadvertent cuff exposure led to ascending infection, among them 6 cases were controlled with catheter removal and the rest of them was controlled with aseptic dressing and antibiotics. Five out of 16 cases (5.3%) with bacteremia were not controlled with antibiotics and resulted in catheter removal. CONCLUSION: To avoid unfavorable complications such as uncontrolled hematoma or bacteremia, fluoroscopic guide insertion and aseptic handling of exit site is important. And it should be remembered that location of cuff should be far from the exit site (> 2 cm) to avoid inadvertent traction.