Infection associated with double lumen catheterization for temporary haemodialysis: Experience of 168 cases

A total of 227 patients with renal failure requiring acute haemodialysis with placement of a total of 260 Medcorp double lumen catheters at National Taiwan University Hospital from July 1992 to July 1993 were reviewed. Among them, only 135 patients receiving a total of 168 catheter placements and a complete infectious work-up were selected for this study. The mean age of the patients was 55 years (range 15–89 years); 63 (46.%) were male and 75 (53.3%) were female. The three major reasons for dialysis were chronic glomerular disease (CGN; 49%), diabetic nephropathy (13%) and nephritis associated with systemic lupus erythematosus (SLE; 11%). The catheters remained in place for an average of 27.8 days (9–73 days) and each catheter was used for an average of eight treatments (2–26). The reasons for catheter removal were classified as: availability of permanent vascular access (48%), recovery of renal function (10%), scheduled duration (30 days, not every case; 4%), expiration of patient (10%), suspicion of catheter-related infections (15%), and catheter thrombosis/occlusion (9%). Seven cases with local haematoma and one case of pneumothorax were also identified (total 5%). In total, a 21.4% catheter-related infection rate was observed and micro-organisms such as Staphylococcus aureus (33%), coagulase-negative staphylococci (36%) and Enterococcus (19%) were isolated. The cumulative probability of patients remaining free from catheter-related infections was about 75% by the end of the fourth week post-catheter insertion, and decreased to less than 50% near the end of the second month of persistent catheterization. In the group of relatively immunocompromised individuals, such as diabetes mellitus patients receiving insulin therapy, patients receiving immunosuppressive agents and cancer patients, the probability of remaining free from catheter-related infection was significantly smaller than that of all patients and that of the non-immunocompromised group. Univariant analysis of risk factors revealed that serum creatinine level at the time of catheter insertion, immune status, number of dialysis treatments per catheter and local skin condition upon catheter removal were significant. There was no absolute correlation between an increased rate of infection and site of catheter insertion, skin condition on insertion, duration of catheterization or azotaemia level. Even so, we recommend early removal of double-lumen catheter, at least within 2 months of catheter indwelling. In uraemic patients with a relatively immunocompromised status (such as diabetes mellitus, malignancy or taking immunosuppressive agents), routine administration of prophylactic antibiotics may prevent future catheter-related infections. Although percutaneous central venous double-lumen catheterization is an effective means of temporary vascular access for acute haemodialysis, complications of catheter-related infections should not be overlooked. Local care of the peri-catheter insertion site is the most important issue for both early detection and prevention of such events.