CENTRAL VENOUS CATHETERS FOR HEMODIALYSIS AND ASSOCIATED BACTEREMIA -A PROSPECTIVE CLINICAL-TRIAL

In hemodialysis by central venous catheters little is known about the influence of difficult catheter insertion on infectious complications. In 34 patients requiring dialysis the incidence of bacteremia was inv estigated after insertion of 57 central venous catheters. Prospectivel y catheter insertions were assigned to 3 groups: I. simple puncture, I I. difficult or multiple puncture, III. exchange of the catheter by gu idewire. Blood for culture of microorganisms was taken in the beginnin g of every dialysis. During 533 catheter days 273 blood samples were c ollected. The overall incidence of bacteremia observed was 3.0/100 cat heter days (cd). Results also demonstrate a significant increase of ba cteremia from group I (2.0/100 cd) to group III (8.2/100 cd). Duration of catheterization periods was significantly reduced in groups II (7. 9 days) and III (5.5 days) compared to group I (12.6 days). We conclud e considering the increased risk of infection that change of catheters by guidewire cannot be recommended. In case of 2 failed puncture atte mpts a new puncture site should be chosen.