Central venous catheters for hemodialysis and associated bacteremia: A prospective clinical trial.

In hemodialysis by central venous catheters little is known about the influence of difficult catheter insertion on infectious complications. In 34 patients requiring dialysis the incidence of bacteremia was investigated after insertion of 57 central venous catheters. Prospectively catheter insertions were assigned to 3 groups: I. simple puncture, II. difficult or multiple puncture, III. exchange of the catheter by guidewire. Blood for culture of microorganisms was taken in the beginning of every dialysis. During 533 catheter days 273 blood samples were collected. The overall incidence of bacteremia observed was 3.0/100 catheter days (cd). Results also demonstrate a significant increase of bacteremia from group I (2.0/100 cd) to group III (8.2/100 cd). Duration of catheterization periods was significantly reduced in groups II (7.9 days) and III (5.5 days) compared to group I (12.6 days). We conclude considering the increased risk of infection that change of catheters by guidewire cannot be recommended. In case of 2 failed puncture attempts a new puncture site should be chosen.