Conversion from temporary to tunneled catheters by nephrologists: report of a single-center experience

Abstract

Background: Nephrologists have increasingly participated in the conversion from temporary catheters (TC) to tunneled-cuffed catheters (TCCs) for hemodialysis.

Objective: To prospectively analyze the outcomes associated with TCC placement by nephrologists with expertise in such procedure, in different time periods at the same center. The impact of vancomycin or cefazolin as prophylactic antibiotics on the infection outcomes was also tested.

Patients and methods: Hemodialysis patients who presented to such procedure were divided into two cohorts: A (from 2004 to 2008) and B (from 2013 to 2015). Time from TC to TCC conversion, prophylactic antibiotics, and reasons for TCC removal were evaluated.

Results: One hundred and thirty patients were included in cohort A and 228 in cohort B. Sex, age, and follow-up time were similar between cohorts. Median time from TC to TCC conversion was longer in cohort A than in cohort B (14 [3; 30] vs 4 [1; 8] days, respectively; P⩽0.0001). Infection leading to catheter removal occurred in 26.4% vs 18.9% of procedures in cohorts A and B, respectively, and infection rate was 0.93 vs 0.73 infections per 1,000 catheter-days, respectively (P=0.092). Infection within 30 days from the procedure occurred in 1.4% of overall cohort. No differences were observed when comparing vancomycin and cefazolin as prophylactic antibiotics on 90-day infection-free TCC survival in a Kaplan-Meier model (log-rank = 0.188). TCC removal for low blood flow occurred in 8.9% of procedures.

Conclusion: Conversion of TC to TCC by nephrologists had overall infection, catheter patency, and complications similar to data reported in the literature. Vancomycin was not superior to cefazolin as a prophylactic antibiotic.

Keywords: infection; interventional nephrology; prophylactic antibiotics; renal dialysis; temporary catheters; tunneled catheters.

Figure 1

Cohort description.

Figure 2

Kaplan–Meier curves for cohorts A and B. Note: Event: infection leading to catheter removal within 90 days from TCC insertion, censored by other causes of catheter removal. Abbreviation: TCC, tunneled-cuffed catheter.

Figure 3

Infection-free TCC survival in the first 90 days according to the prophylactic antibiotics. Notes: (A) Non-adjusted Kaplan–Meier curves. (B) A Cox regression analysis in a model adjusted for age, diabetes mellitus in cohort A vs B and duration of TC prior to TCC conversion. Abbreviations: TC, temporary catheter; TCC, tunneled-cuffed catheter.