TREATMENT OF INFECTED TUNNELED VENOUS ACCESS HEMODIALYSIS CATHETERS WITH GUIDEWIRE EXCHANGE

Cuffed venous access catheters have become commonplace for hemodialysi s access. The major complications of these catheters are catheter thro mbosis, catheter fibrin sheathing and infection. When catheter associa ted bacteremia occurs treatment with antimicrobial therapy alone has b een unsuccessful in providing acceptable cure rates. Failed antimicrob ial therapy exposes the patient to the risks of prolonged bacteremia, while the alternative, catheter replacement at a new site can lead to central venous stenosis and compromise future long-term upper extremit y access. Catheter guidewire exchange when the tunnel tract is clinica lly not infected theoretically allows the preservation of future acces s sites and yields a higher treatment success rate while avoiding temp orary non-cuffed access placement. We report a series of 23 cases of h emodialysis patients with tunneled cuffed catheters and bacteremia rel ated to the catheter who were treated with the exchange of a new cathe ter over a guidewire combined with three weeks of systemic antibiotics . Patients eligible for the study required no evidence of tunnel tract infection and defervescence within 48 hours of antimicrobial therapy. Technique failure was defined as repeat infection from any organism w ithin 90 days of catheter exchange. Four patients (18%) redeveloped ba cteremia within 90 days of the exchange. The bacteremias developed at 4, 19, 63 and at 74 days days after the exchange. Guidewire exchange i n combination with intravenous antibiotics in cases of catheter relate d bacteremia has an acceptable rate of treatment success and is a viab le treatment option in a carefully selected patient population.