Risk of bacteremia from temporary hemodialysis catheters by site of insertion and duration of use: A prospective study

Background Uncuffed, nontunneled hemodialysis catheters remain the preferre d means to gain immediate access to the circulation for hemodialysis. Bacte remia is the primary complication that limits their use. The risk of bacter emia by site of insertion and duration of use has not been well studied. Methods. Two hundred eighteen consecutive patients who required a temporary hemodialysis catheter were prospectively followed. Results. Catheters were placed at 318 new insertion sites and remained in u se for a total of 6235 days. The incidence of bacteremia was 5.4% after thr ee weeks of placement in internal jugular vein and 10.7% after one week in femoral vein [relative risk for bacteremia 3.1 (95% CI, 1.8 to 5.2)]. The i ncidence of bacteremia was 1.9% one day after the onset of an exit site inf ection but increased to 13.4% by the second day if: the catheter was not re moved. Guidewire exchange for malfunction and patient factors did not signi ficantly affect the risk of bacteremia. Conclusions. Internal jugular catheters may be left in place for up to thre e weeks without a high risk of bacteremia, but femoral catheters in bed-bou nd patients should be removed after one week. Catheter exchanges over a gui dewire for catheter malfunction do not increase bacteremia rates. Temporary catheters should be removed immediately if an exit site infection occurs.