Is there an association between central vein stenosis and line infection in patients with tunnelled central venous catheters (TCVCs)?

Purpose: Central vein stenosis (CVS) and line infection are well-recognized complications of tunnelled central venous catheters (TCVCs) in patients on haemodialysis. The aim of this study was to evaluate any relationship between CVS and line infection. Methods: Analysis of 500 consecutive patients undergoing TCVC insertion was undertaken. Data were collected on patient demographics, details of line insertion and duration, culture-proven bacteraemia and presence of symptomatic CVS. Logistic regression analysis was used to determine risk factors for CVS and bacteraemia. Results: Mean patient age was 59.0 years (range: 17-93). Mean number of catheter days was 961.1 +/- 57.6 per TCVC; 39.4% of TCVCs were associated with culture-proven bacteraemia and 23.6% developed symptomatic CVS. Bacteraemia and CVS were inevitable complications of all TCVCs. The time to symptomatic CVS was longer in patients with bacteraemia than without (1230.91 +/- 101.29 vs. 677.49 +/- 61.59 days, p<0.001). Patients who had early infection within 90 days of TCVC insertion were less likely to develop CVS (5.9% vs. 22.8%, p<0.001). There was no difference in the bacteraemia rate per 1,000 catheter days between patients with and without CVS (2.62 +/- 1.41 vs. 2.35 +/- 0.51; p = 0.98). Number of line days (odds ratio (OR) 1.02, p = 0.003), age (OR 1.04, p = 0.04) and culture-proven line infection (OR 0.59, p = 0.014) were all independently associated with CVS. Conclusions: Our results suggest that early line infection may be protective against CVS. Alternatively, there may be two distinct predisposition states for CVS and line infection. Further studies are needed to confirm our association and investigate causation.