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

1 Ravani P, Palmer SC, Oliver MJ, et al. Associations between hemodialysis access type and clinical outcomes: a systematic review. J Am Soc Nephrol. 2013;24(3):465-73. http://dx.doi.org/10.1681/ASN.2012070643. PMid:23431075.

2 Sesso RC, Lopes AA, Thomé FS, Lugon JR, Martins CT. Brazilian chronic dialysis survey 2016. J Bras Nefrol. 2017;39(3):261-6. http://dx.doi.org/10.5935/0101-2800.20170049. PMid:29044335.

3 Grothe C, Belasco AGS, Bittencourt ARC, Vianna LAC, Sesso RCC, Barbosa DA. Incidência de infecção da corrente sanguínea nos pacientes submetidos à hemodiálise por cateter venoso central. Rev Lat Am Enfermagem. 2010;18(1):73-80. http://dx.doi.org/10.1590/S0104-11692010000100012. PMid:20428700.

4 Böhlke M, Uliano G, Barcellos FC. Hemodialysis catheter-related infection: prophylaxis, diagnosis and treatment. J Vasc Access. 2015;16(5):347-55. http://dx.doi.org/10.5301/jva.5000368. PMid:25907773.

5 Bonfante GM, Gomes IC, Andrade EIG, Lima EM, Acurcio FA, Cherchiglia ML. Duration of temporary catheter use for hemodialysis: an observational, prospective evaluation of renal units in Brazil. BMC Nephrol. 2011;12(1):63. http://dx.doi.org/10.1186/1471-2369-12-63. PMid:22093280.

6 Miller LM, Clark E, Dipchand C, et al. Hemodialysis tunneled catheter-related infections. Can J Kidney Health Dis. 2016;3. PMid:28270921.

7 Menegueti MG, Betoni NC, Bellissimo-Rodrigues F, Romão EA. Central venous catheter-related infections in patients receiving short-term hemodialysis therapy: incidence, associated factors, and microbiological aspects. Rev Soc Bras Med Trop. 2017;50(6):783-7. http://dx.doi.org/10.1590/0037-8682-0438-2017. PMid:29340455.

8 Schwanke AA, Danski MTR, Pontes L, Kusma SZ, Lind J. Central venous catheter for hemodialysis: incidence of infection and risk factors. Rev Bras Enferm. 2018;71(3):1115-21. http://dx.doi.org/10.1590/0034-7167-2017-0047. PMid:29924154.

9 Ferreira V, Andrade D. Cateter para hemodiálise: retrato de uma realidade. Medicina (B Aires). 2007;40(4):582. http://dx.doi.org/10.11606/issn.2176-7262.v40i4p582-588.

10 Martín-Peña A, Márquez RL, Guerrero MJM, et al. Tunneled hemodialysis catheter-related bloodstream infections: a prospective multicenter cohort study from Spain. J Vasc Access. 2012;13(2):239-45. http://dx.doi.org/10.5301/jva.5000034. PMid:22266591.

11 Fram D, Okuno MFP, Taminato M, et al. Risk factors for bloodstream infection in patients at a Brazilian hemodialysis center: a case-control study. BMC Infect Dis. 2015;15(1):158. http://dx.doi.org/10.1186/s12879-015-0907-y. PMid:25879516.

12 Marik PE, Flemmer M, Harrison W. The risk of catheter-related bloodstream infection with femoral venous catheters as compared to subclavian and internal jugular venous catheters: a systematic review of the literature and meta-analysis. Crit Care Med. 2012;40(8):2479-85. http://dx.doi.org/10.1097/CCM.0b013e318255d9bc. PMid:22809915.

13 Clark EG, Barsuk JH. Temporary hemodialysis catheters: recent advances. Kidney Int. 2014;86(5):888-95. http://dx.doi.org/10.1038/ki.2014.162. PMid:24805107.

14 Shingarev R, Barker-Finkel J, Allon M. Natural history of tunneled dialysis catheters placed for hemodialysis initiation. J Vasc Interv Radiol. 2013;24(9):1289-94. http://dx.doi.org/10.1016/j.jvir.2013.05.034. PMid:23871694.

15 Engstrom BI, Horvath JJ, Stewart JK, et al. Tunneled internal jugular hemodialysis catheters: impact of laterality and tip position on catheter dysfunction and infection rates. J Vasc Interv Radiol. 2013;24(9):1295-302. http://dx.doi.org/10.1016/j.jvir.2013.05.035. PMid:23891045.

16 Mandolfo S, Acconcia P, Bucci R, et al. Hemodialysis tunneled central venous catheters: five-year outcome analysis. J Vasc Access. 2014;15(6):461-5. http://dx.doi.org/10.5301/jva.5000236. PMid:24811590.

17 Shi M, Cui T, Ma L, Zhou L, Fu P. Catheter failure and mortality in hemodialysis patients with tunneled cuffed venous catheters in a single center. Blood Purif. 2017;43(4):321-6. http://dx.doi.org/10.1159/000455062. PMid:28135701.

18 Hammarskjöld F, Berg S, Hanberger H, Taxbro K, Malmvall B-E. Sustained low incidence of central venous catheter-related infections over six years in a Swedish hospital with an active central venous catheter team. Am J Infect Control. 2014;42(2):122-8. http://dx.doi.org/10.1016/j.ajic.2013.09.023. PMid:24485369.

19 Arhuidese IJ, Orandi BJ, Nejim B, Malas M. Utilization, patency, and complications associated with vascular access for hemodialysis in the United States. J Vasc Surg. 2018;68(4):1166-74. http://dx.doi.org/10.1016/j.jvs.2018.01.049. PMid:30244924.

20 Wang K, Wang P, Liang X, Lu X, Liu Z. Epidemiology of haemodialysis catheter complications: a survey of 865 dialysis patients from 14 haemodialysiscentres in Henan province in China. BMJ Open. 2015;5(11):e007136. http://dx.doi.org/10.1136/bmjopen-2014-007136. PMid:26589425.

21 Mendu ML, May MF, Kaze AD, et al. Non-tunneled versus tunneled dialysis catheters for acute kidney injury requiring renal replacement therapy: a prospective cohort study. BMC Nephrol. 2017;18(1):351. http://dx.doi.org/10.1186/s12882-017-0760-x. PMid:29202728.

22 Taylor G, Gravel D, Johnston L, Embil J, Holton D, Paton S. Incidence of bloodstream infection in multicenter inception cohorts of hemodialysis patients. Am J Infect Control. 2004;32(3):155-60. http://dx.doi.org/10.1016/j.ajic.2003.05.007. PMid:15153927.

23 Sahli F, Feidjel R, Laalaoui R. Hemodialysis catheter-related infection: rates, risk factors and pathogens. J Infect Public Health. 2017;10(4):403-8. http://dx.doi.org/10.1016/j.jiph.2016.06.008. PMid:27423929.

24 Murea M, James KM, Russell GB, et al. Risk of catheter-related bloodstream infection in elderly patients on hemodialysis. Clin J Am Soc Nephrol. 2014;9(4):764-70. http://dx.doi.org/10.2215/CJN.07710713. PMid:24651074.

25 Esmanhoto CGU, Taminato MU, Fram DSU, Belasco AGSU, Barbosa DAU. Microrganismos isolados de pacientes em hemodiálise por cateter venoso central e evolução clínica relacionada. Acta Paul Enferm. 2013;26(5):413-20.

26 Zerati AE, Wolosker N, Luccia N, Puech-Leão P. Cateteres venosos totalmente implantáveis: histórico, técnica de implante e complicações. J Vasc Bras. 2017;16(2):128-39. http://dx.doi.org/10.1590/1677-5449.008216. PMid:29930637.

27 Barbosa DA, Gunji CK, Bittencourt ARC, et al. Co-morbidade e mortalidade de pacientes em início de diálise. Acta Paul Enferm. 2006;19(3):304-9. http://dx.doi.org/10.1590/S0103-21002006000300008.

28 Rosenberry PM, Niederhaus SV, Schweitzer EJ, Leeser DB. Decreasing dialysis catheter rates by creating a multidisciplinary dialysis access program. J Vasc Access. 2018;19(6):569-72. http://dx.doi.org/10.1177/1129729818762977. PMid:29575978.

29 Saleh HM, Tawfik MM, Abouellail H. Prospective, randomized study of long-term hemodialysis catheter removal versus guidewire exchange to treat catheter-related bloodstream infection. J Vasc Surg. 2017;66(5):1427-1431.e1. http://dx.doi.org/10.1016/j.jvs.2017.05.119. PMid:28822660.
 


Submitted date:
11/06/2019

Accepted date:
04/24/2020

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
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