Haemodialysis

Abstract

Introduction: Vascular access is lifeline for haemodialysis (HD) patients.Catheter related infections limit the duration of such devices and are important cause ofmorbidity in this population the main complication of catheter in hemodialysis is infection.Objectives: To determine frequency of haemodialysis Catheter Related Infections inhaemodialysis patients. Study Design: Prospective study. Place and Duration: This studywas conducted at Department of Nephrology, King Abdul Aziz Specialists Hospital, Taif, SaudiArabia in 1 year from Jan to Dec 2017. Methodology: This study included one hundred sixteenadults who underwent catheterization for Haemodialysis. These patients were evaluated todetermine the incidence of catheter related infections. At each dialysis session patients wereclinically examined and cultures taken from exit site and blood. Ten malfunctioning catheterswere changed over guide wire. At the time of catheter removal or change catheter tips weresent for culture. Results: Total of 116 catheters (50 femoral, 52 jugular, 14 subclavian) wereevaluated. Duration of catheterization varied from 2-70 days (average 21 days) for jugular andsubclavian whereas for femoral catheters it was 1-30 days (mean 8.4 days). Exit site cultureswere positive in 76 (66%) patients and common organism were Staphylococcus epidermis 32,Staphylococcus aureus 24, Gram negative rods in 12 and mix growth in 08 patients. Clinicalsepsis was observed in 27(23%) patients (fever with /without chills, purulent discharge aroundcatheter. One patient had endocarditis with big mass in right atrium). Organism isolated fromthese patients were (Staphylococcus aureus 11, Staphylococcus epidermis 8, gram negative5). Bacteremia alone was observed in 13 (11%) patients. Of 10 patients with soaked dressing7 (70%) patients subsequently became febrile. In all these patients catheters were removedand antibiotics instituted. Although clinical sepsis was more with jugular than femoral cathetersbut could be related to longer duration of jugular catheters. Catheters removed from febrilepatients had much higher rate of colonization and bacteremia. Catheter exchange over guidewire was not associated with higher infection rates. Conclusions: Catheter related infection stillremain high in dialysis population. Staphylococcus epidermis and Staphylococcus aureus werecommonly isolated organisms. Cather sepsis was an important cause of morbidity in thesepatients. Long duration of catheterization, soaked dressing and colonization were importantrisk factors.