Preventing catheter-related infections in children undergoing hemodialysis

Abstract

The increased use of tunneled cuffed catheters in children on chronic hemodialysis is the result of their relative ease of insertion, pain-free dialysis and immediate use. The disadvantage of their use is that they are associated with catheter-related bacteremia (CRB), which in turn is related with increased morbidity, access loss and occasionally metastatic infections and even death. A CRB might be difficult to diagnose and is often associated with a previous history of CRB, exit-site infection, low serum albumin and long duration of catheter use. There is evidence that the use of arteriovenous fistulae is associated with lower infection rates. The implementation of effective strategies for the prevention of CRBs include the adoption of policies for improving arteriovenous fistula rates, appropriate surgical catheter insertion and optimal nursing care of the exit site, and a safe connection technique. Recently, the effectiveness of antimicrobial catheter solutions for preventing CRB has been documented in a number of randomized clinical trials. In addition, the application of antibiotic ointments at the exit sites of tunneled cuffed catheters might be significant for the reduction of Staphylococcus-related CRB. The upside is that education-based programs combining specific preventive measures can significantly reduce CRBs.

Split catheters in children on chronic hemodialysis: A single‐center experience

“…Most studies reported an incidence of BSI between 1.5 and 8.6/1000 CVC days . It has been postulated that rates above 2 per 1000 catheter days suggest serious problems with effective bacteremia prevention . Our experience is similar to that of Eisenstein, who showed an infection rate of 0.52/1000 CVC days, obtained by adhering to a strict catheter management protocol .…”

Vascular access: choice and complications in European paediatric haemodialysis units

“…Catheter-related bacteraemia rates in children on HD were found to vary 1.5 and 8.6/1000 catheter days in different series involving from 13 up to 89 patients [7,[21][22][23][24][25][26][27][28]. In our study, the overall rate of CVC-related infections requiring intravenous antibiotics was 1.9 episodes/1000 catheter days, with a smaller number requiring CVC changes (0.9 episodes/1000 catheter days).…”

“…Although the use of anaesthetic creams and other agents has helped to reduce the pain of venipuncture, CVCs do offer needle-free dialysis. The benefits must be balanced against the increased risks of catheter malfunction with poor blood flows, catheterrelated infection episodes, as well as restrictions on bathing and swimming [6,7]. CVCs might also contribute to increased inflammation independent of infection [8].…”

Reduction in catheter‐related infections after switching from povidone‐iodine to chlorhexidine for the exit‐site care of tunneled central venous catheters in children on hemodialysis

“…12,13,16,26 The Center for Disease Control recommends the use of 2% chlorhexidine, 25 but this recommendation is based on studies involving mainly adult intensive care patients with temporary catheters, and very few data are available concerning patients with tunneled HD catheters. 12,13,16,26 The Center for Disease Control recommends the use of 2% chlorhexidine, 25 but this recommendation is based on studies involving mainly adult intensive care patients with temporary catheters, and very few data are available concerning patients with tunneled HD catheters.…”

“…[7][8][9][10][11] Although it is true that optimal CVC management can control such infections, most of the current recommendations are based on little evidence. [12][13][14][15][16] The choice of exit-site and hub cleaning solution is a key point in the prevention of exit-site infection (ESI), tunnel infection (TI), and bloodstream infection (BSI) in patients on HD, and the findings of many studies, metaanalyses, and guidelines suggest that a chlorhexidine gluconate solution is better than a povidone-iodine solution for this purpose. [17][18][19][20][21][22][23][24][25][26][27] Unfortunately, most of these studies involved temporary CVCs and adults not receiving HD, and only one retrospective single-centre study has compared 2% chlorhexidine and 5% povidone-iodine in the exit-site care of children on HD.…”