Outcome and complications of temporary haemodialysis catheters

Background. The use of temporary haemodialysis catheters is often complicat ed by mechanical dr infectious complications. Risk-factors for these compli cations and optimal management to reduce their incidence are largely unknow n. Methods. We conducted a prospective study of 105 haemodialysis catheters (7 9 subclavian, 26 jugular) inserted in 52 patients in order to identify pati ent outcomes and to analyse the effect of patient and catheter factors on t he incidence of infectious complications by multivariate analysis. Results. Fifty-nine per cent of catheters were removed for a suspected comp lication. Catheter-related bacteraemia (CRB) was diagnosed in 17 catheters (16%), giving a bacteraemia rate of 6.5 episodes per 1000 catheter days. Su bgroup analysis revealed a higher risk of CRB with the use of the internal jugular compared with the subclavian site (hazard ratio 3.97, P = 0.02). Ag e, diabetes or catheter exchange over a guidewire did not alter the risk of CRB. The cumulative risk of developing CRB increased in a linear fashion a s the period of catheterization increased. Exit-site infection was the caus e for removal in eight catheters (8%). Although the number of exit-site inf ections was small, the risk of exit-site infection was increased in diabeti c patients (hazard ratio 10, P = 0.03) and the jugular position (hazard rat io 6.5, P = 0.01) but not by age or catheter exchange over a guidewire. Sta phylococcus aureus and coagulase-negative staphylococcus accounted for all proven episodes of CRB. Exit-site infection was associated with a mixture o f Grampositive and Gram-negative organisms. Conclusions. Temporary haemodialysis catheters have a high failure rate ass ociated with a significant rate of complications. Use of the internal jugul ar site is associated with a significantly higher risk of infectious compli cations and methods to reduce this risk should be considered if this site i s used.