Low Infection Rates and Prolonged Survival Times of Hemodialysis Catheters in Infants and Children

Abstract

SummaryBackground and objectives Hemodialysis (HD) catheter-related complications are regarded as the main cause of HD failure in infants and children with ESRD. In this study, we determined HD catheter infection rates and survival times in children. Results Twenty-nine children with ESRD (median age, 10 years) received HD through a CVC, for a total of 22,892 days during the study period. Eleven (38%) children were infants (Ͻ1 year of age) who received HD for a cumulative 3779 days (16% of total). Fifty-nine CVCs were inserted, of which 13 (22%) were in infants. There were 12 episodes of CVC infection-a rate of 0.52/1000 CVC days. Four (33%) episodes occurred in infants-a rate of 1.06/1000 CVC days. Only three (5%) of the CVCs were removed because of infection. Median catheter survival time for all children was 310 days and for infants was 211 days.Conclusions Very low CVC infection rates (one infection per 5 CVC years) and prolonged CVC survival times (around 1 year) are achievable in infants and children with ESRD receiving HD therapy by adhering to a strict catheter management protocol and without using prophylactic antibiotic therapy.

Mortality Risk Among Children Initially Treated With Dialysis for End-Stage Kidney Disease, 1990-2010

“…17 Strict infection control practices may have decreased hemodialysis catheter infections. 30 Pneumococcal and influenza vaccination, which are associated with decreased mortality in adults with ESKD, 31 have been increasingly used over the past decade in children with ESKD. 1 Improvement in anemia care may have contributed to decreased cardiovascular risk.…”

Complications of Central Venous Access Devices: A Systematic Review

“…Twelve studies 59,61,66,67,72,76,82,83,89,97,105,121 described the outcome of CVADassociated BSI without the clarity and rigor of benchmarked standards, which meant that their CVAD-associated BSI data were not included in the review. Two studies 30,116 provided combined "all-type" infection or mechanical failure outcomes, instead of providing separated local and systemic infection, occlusion, and dislodgement data. These data also were not included in the review.…”

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

“…12,15 Our study can contribute to this in that it emphasizes the importance of exit-site and hub cleaning solutions. As optimal CVC management is the cornerstone of infection control, identifying the most effective strategy is of utmost importance.…”

“…[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.…”