Fibrin sheath disruption during guidewire exchange for bacteremia: Low recurrence of infection and preservation of vascular access sites

Abstract

Background:

Catheter-associated bacteremia (CAB) often leads to removal of tunneled dialysis catheters with delayed insertion (RDI). Exchange over a guidewire (ExW) can be considered for access site preservation. Fibrin sheath disruption (FSD) during exchange is not standard practice for infected catheters. Here we present the first analysis of outcomes after such exchanges (ExW-FSD).

Methods:

Retrospective analysis of catheter exchanges and removals performed by interventional nephrology for bacteremia in 2008–2011 observed for 20.5 months. Charts were reviewed for recurrent or new bacteremia and death at 3 months, and for occurrence of thrombosis or stenosis along the catheter site. Catheter exchange with central venogram and fibrin sheath disruption was our standard of care in all patients presenting for CAB. RDI was performed either for tunnel infection, non-clearing of infection or at the request of referring physicians.

Results:

Over 4 years, 66 patients were treated for CAB. Forty-two patients underwent ExW-FSD, which was performed even for Staph. aureus, gram negative bacteremia or candidemia. RDI was performed in 24 cases. Bacteremia recurred in 3 (7%) patients after ExW-FSD, and in 7 (30%) cases after RDI (p = 0.02). There was no significant difference in new infections: 5 (12%) after ExW-FSD and 2 (8%) after RDI. There was no death within 3 months after ExW-FSD and 4 (27%) (p = 0.005) deaths in the RDI group.

There was one new central venous stenosis in the ExW-FSD group (2%) with no loss of access site, and 8 (33%) patients developed thrombosis/stenosis along the prior catheter track after RDI (33%) (p = 0.006) with loss of access site in (21%).

Conclusions:

In this retrospective analysis of treatment of CAB, ExW-FSD was associated with lower recurrence of bacteremia, lower death rate and a lower incidence of access site loss compared to RDI. These data support ExW-FSD use in patients with CAB.

Keywords

Tunneled catheter dialysis vascular access fibrin sheath disruption guidewire exchange catheter-associated bacteremia

Get full access to this article

View all access options for this article.

References

Little

O’Riordan

Lucey

, et al. A prospective study of complications associated with cuffed, tunnelled haemodialysis catheters. Nephrol Dial Transplant 2001; 16: 2194–2200.

Alomari

Falk

The natural history of tunneled hemodialysis catheters removed or exchanged: a single-institution experience. J Vasc Interv Radiol 2007; 18: 227–235.

Develter

De Cubber

Van Biesen

, et al. Survival and complications of indwelling venous catheters for permanent use in hemodialysis patients. Artif Organs 2005; 29: 399–405.

Marr

Sexton

Conlon

, et al. Catheter-related bacteremia and outcome of attempted catheter salvage in patients undergoing hemodialysis. Ann Intern Med 1997; 127: 275–280.

Beathard

Urbanes

Infection associated with tunneled hemodialysis catheters. Semin Dial 2008; 21: 528–538.

KDOQI and National Kidney Foundation. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease. Am J Kidney Dis 2006; 47: S11–S145.

Lok

Huber

Lee

, et al. KDOQI clinical practice guideline for vascular access: 2019 update. Am J Kidney Dis 2020; 75(4): 1–164.

Mermel

Farr

Sherertz

, et al. Guidelines for the management of intravascular catheter-related infections. Clin Infect Dis 2001; 32: 1249–1272.

Beathard

GA.

Management of bacteremia associated with tunneled-cuffed hemodialysis catheters. J Am Soc Nephrol 1999; 10: 1045–1049.

10.

Mokrzycki

Zhang

Cohen

, et al. Tunnelled haemodialysis catheter bacteraemia: risk factors for bacteraemia recurrence, infectious complications and mortality. Nephrol Dial Transplant 2006; 21: 1024–1031.

11.

Tanriover

Carlton

Saddekni

, et al. Bacteremia associated with tunneled dialysis catheters: comparison of two treatment strategies. Kidney Int 2000; 57: 2151–2155.

12.

Cassidy

Jr Zajko

Bron

, et al. Noninfectious complications of long-term central venous catheters: radiologic evaluation and management. AJR Am J Roentgenol 1987; 149: 671–675.

13.

Crain

Horton

Mewissen

MW.

Fibrin sheaths complicating central venous catheters. AJR Am J Roentgenol 1998; 171: 341–346.

14.

Hoshal

Jr Ause

Hoskins

PA.

Fibrin sleeve formation on indwelling subclavian central venous catheters. Arch Surg 1971; 102: 353–358.

15.

Oliver

Mendelssohn

Quinn

, et al. Catheter patency and function after catheter sheath disruption: a pilot study. Clin J Am Soc Nephrol 2007; 2: 1201–1206.

16.

Shanaah

Brier

Dwyer

Fibrin sheath and its relation to subsequent events after tunneled dialysis catheter exchange. Semin Dial 2013; 26: 733–737.

17.

Liangos

Gul

Madias

, et al. Long-term management of the tunneled venous catheter. Semin Dial 2006; 19: 158–164.

18.

Raad

Hohn

Gilbreath

, et al. Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion. Infect Control Hosp Epidemiol 1994; 15: 231–238.

19.

Stewart

Costerton

JW.

Antibiotic resistance of bacteria in biofilms. Lancet 2001; 358: 135–138.

20.

Timsit

Farkas

Boyer

, et al. Central vein catheter-related thrombosis in intensive care patients: incidence, risks factors, and relationship with catheter-related sepsis. Chest 1998; 114: 207–213.

21.

Mehall

Saltzman

Jackson

, et al. Fibrin sheath enhances central venous catheter infection. Crit Care Med 2002; 30: 908–912.

22.

Tang

Beigel

Arsanjani

, et al. Infective endovascular fibrin sheath vegetations-a new cause of bacteremia detected by transesophageal echocardiogram. Am J Med 2015; 128: 1029–1038.

23.

Gray

Levitin

Buck

, et al. Percutaneous fibrin sheath stripping versus transcatheter urokinase infusion for malfunctioning well-positioned tunneled central venous dialysis catheters: a prospective, randomized trial. J Vasc Interv Radiol 2000; 11: 1121–1129.

24.

Janne d’Othee

Tham

Sheiman

. Restoration of patency in failing tunneled hemodialysis catheters: a comparison of catheter exchange, exchange and balloon disruption of the fibrin sheath, and femoral stripping. J Vasc Interv Radiol 2006; 17: 1011–1015.

25.

Merport

Murphy

Egglin

, et al. Fibrin sheath stripping versus catheter exchange for the treatment of failed tunneled hemodialysis catheters: randomized clinical trial. J Vasc Interv Radiol 2000; 11: 1115–1120.

26.

Kennard

Walters

Jiang

, et al. Interventions for treating central venous haemodialysis catheter malfunction. Cochrane Database Syst Rev 2017; 10: CD011953.

27.

Valliant

Chaudhry

Yevzlin

, et al. Tunneled dialysis catheter exchange with fibrin sheath disruption is not associated with increased rate of bacteremia. J Vasc Access 2015; 16: 52–56.

28.

Marr

Kong

Fowler

, et al. Incidence and outcome of Staphylococcus aureus bacteremia in hemodialysis patients. Kidney Int 1998; 54: 1684–1689.

29.

Saad

TF.

Bacteremia associated with tunneled, cuffed hemodialysis catheters. Am J Kidney Dis 1999; 34: 1114–1124.

30.

Aslam

Vaida

Ritter

, et al. Systematic review and meta-analysis on management of hemodialysis catheter-related bacteremia. J Am Soc Nephrol 2014; 25: 2927–2941.

31.

Ashby

Power

Singh

, et al. Bacteremia associated with tunneled hemodialysis catheters: outcome after attempted salvage. Clin J Am Soc Nephrol 2009; 4: 1601–1605.

32.

Troidle

Finkelstein

FO.

Catheter-related bacteremia in hemodialysis patients: the role of the central venous catheter in prevention and therapy. Int J Artif Organs 2008; 31: 827–833.

33.

Joshi

Hart

PD.

Antibiotic catheter locks in the treatment of tunneled hemodialysis catheter-related blood stream infection. Semin Dial 2013; 26: 223–226.

34.

Maya

Carlton

Estrada

, et al. Treatment of dialysis catheter-related Staphylococcus aureus bacteremia with an antibiotic lock: a quality improvement report. Am J Kidney Dis 2007; 50: 289–295.

35.

Peterson

Maya

Carlton

, et al. Treatment of dialysis catheter-related Enterococcus bacteremia with an antibiotic lock: a quality improvement report. Am J Kidney Dis 2009; 53: 107–111.

36.

Poole

Carlton

Bimbo

, et al. Treatment of catheter-related bacteraemia with an antibiotic lock protocol: effect of bacterial pathogen. Nephrol Dial Transplant 2004; 19: 1237–1244.

37.

Langer

Cohen

Berns

, et al. Staphylococcus-infected tunneled dialysis catheters: is over-the-wire exchange an appropriate management option? Cardiovasc Intervent Radiol 2011; 34: 1230–1235.

38.

Mojibian

Pollak

, et al. Association between disruption of fibrin sheaths using percutaneous transluminal angioplasty balloons and late onset of central venous stenosis. Cardiovasc Intervent Radiol 2011; 34: 114–119.