Inserting Tunnelled Hemodialysis Catheters Using Elective Guidewire Exchange From Nontunnelled Catheters: Is There a Greater Risk of Infection When Compared Too New-Site Replacement?

Abstract 

The objective of this article was to evaluate bacteremia outcomes and survival rates when using guidewire exchange to place tunnelled hemodialysis catheter (THDC) compared to a new-site replacement. Retrospectively identified all patients who received a THDC between 01/01/2000 and 01/01/2007. Excluded any THDC having received antibiotic line locks or tunnelled to tunnelled exchange. This left 408 THDC placed in 329 patients: 46 guidewire exchange, 362 new-site replacement. Bacteremia rate from the new-site insertion group was 3.0 per 1,000 catheter days, the guidewire exchange group demonstrated a rate of 2.8 per 1,000 catheter days. Local infection rates did not differ between groups at 1.2 per 1,000 catheters days. The actuarial survival rates using Kaplan-Meier survival analysis demonstrated no difference between the two groups. The placing of tunnelled cuffed hemodialysis catheters to replace temporary catheters using a guidewire exchange did not contribute to further episodes of sepsis and has the advantage of preserving venous access and minimizing invasive procedures for the patient.