Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.190142
Jornal Vascular Brasileiro
Original Article

Análise das taxas de infecção e duração de cateteres de hemodiálise de curta e longa permanência em hospital de ensino

Analysis of infection rates and duration of short and long-term hemodialysis catheters in a teaching hospital

Seleno Glauber de Jesus-Silva; Jennifer dos Santos Oliveira; Karine Tobias França Ramos; Luciene Azevedo Morais; Melissa Andreia de Moraes Silva; Arturo Eduardo Krupa; Rodolfo Souza Cardoso

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Resumo

Resumo: Contexto: Os cateteres venosos centrais para hemodiálise (CVCH) de curta permanência (CCP) e cateteres tunelizáveis de longa permanência (CTLP) são fundamentais para a terapia hemodialítica. Entretanto, há escassa casuística nacional acerca da incidência de complicações desses dois tipos de cateteres.

Objetivos: Analisar as complicações e tempo de duração de CVCHs em centro de hemodiálise de hospital de ensino.

Métodos: Foi feito um estudo unicêntrico, longitudinal e retrospectivo de 115 pacientes consecutivos submetidos a implante de cateteres para hemodiálise (67 CCP e 48 CTLP) em um período de 2 anos, com análise de sobrevida geral, perviedade, perda do acesso e incidência de complicações.

Resultados: Sessenta por cento eram do sexo masculino e a média de idade foi de 62 anos. O principal sítio de punção foi a veia jugular interna direita. Hipertensão arterial sistêmica estava presente em 95% dos casos. A mediana de permanência do cateter foi de 50 dias (CCP) versus 112 dias (CTLP; p < 0,0001). Não houve diferença na sobrevida global. Infecção relacionada ao cateter apresentou maior incidência nos CCP, sendo Staphylococcus sp. o microrganismo mais encontrado. A taxa de infecção por 1.000 dias foi maior nos CCP em relação aos CTLP (16,7 eventos/1.000 dias versus 7,0 eventos/1.000 dias, respectivamente). Baixa renda foi o único fator relacionado a maior incidência de infecção.

Conclusões: O tempo de permanência dos CTLP foi significativamente maior que os CCP, porém ainda assim abaixo dos valores relatados na literatura e sem impacto na sobrevida global. Baixa renda foi um fator associado a infecção de cateter.

Palavras-chave

diálise renal, infecções relacionadas a cateter, cateteres de demora

Abstract

Background: Short-term (ST) and long-term tunneled (LTT) central venous catheters for hemodialysis (CVCH) are critical for hemodialysis therapy. However, few studies have been conducted in Brazil to investigate the incidence of complications with these two types of catheters. Objectives: To analyze complications and duration of CVCH in a hemodialysis center at a teaching hospital. Methods: Single-center, longitudinal, and retrospective study of 115  consecutive patients undergoing hemodialysis catheter placement (67 ST and 48 LTT) over a 2-year period, analyzing overall survival, patency, loss of access, and incidence of complications. Results: Sixty percent of the patients were male and mean age was 62 years. The most common puncture site was the right internal jugular vein. Systemic arterial hypertension was present in 95% of cases. Median catheter in-place duration was 50 days (ST) vs. 112 days (LTT; p < 0.0001). There was no difference in overall survival. Incidence of catheter-related infection was higher in ST CVCH, with Staphylococcus sp. the microorganism most often found. The infection rate per 1000 days was higher in ST than in LTT catheters (16.7 events/1000 days vs. 7.0 events/1000 days). Low income was the only factor related to higher incidence of infection. Conclusions: The in-place duration of long-term catheters was significantly longer compared to short-term CVCH, but still below the values reported in the literature and without impact on overall survival. Low income was a factor associated with catheter infection.

Keywords

renal dialysis; catheter-related infections; indwelling catheters.

References

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Submitted date:
11/06/2019

Accepted date:
04/24/2020

5f6a16620e88258a239fefc6 jvb Articles

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