scholarly journals Central Venous Disease Increases the Risk of Microbial Colonization in Hemodialysis Catheters

2021 ◽  
Vol 8 ◽  
Author(s):  
Xianhui Liang ◽  
Yamin Liu ◽  
Bohan Chen ◽  
Ping Li ◽  
Peixiang Zhao ◽  
...  

Objectives: Tunneled-cuffed catheters (TCCs) are widely used in maintenance hemodialysis patients. However, microbial colonization in catheters increases the likelihood of developing various complications, such as catheter-related infection (CRI), catheter failure, hospitalization, and death. Identification of the risk factors related to microorganism colonization may help us reduce the incidence of these adverse events. Therefore, a retrospective analysis of patients who underwent TCC removal was conducted.Methods: From a pool of 389 adult patients, 145 were selected for inclusion in the study. None of the patients met the diagnostic criteria for CRI within 30 days before recruitment. The right internal jugular vein was the unique route evaluated. The catheter removal procedure was guided by digital subtraction angiography. Catheter tips were collected for culture. Biochemical and clinical parameters were collected at the time of catheter removal.Results: The average age of this cohort was 55.46 ± 17.25 years. A total of 45/145 (31.03%) patients were verified to have a positive catheter culture. The proportions of gram-positive bacteria, gram-negative bacteria, and fungi were 57.8, 28.9, and 13.3%, respectively. History of CRI [odds ratio (OR) = 2.44, 95% confidence interval (CI) 1.09 to 5.49], fibrin sheath (OR = 2.93, 95% CI 1.39–6.19), white blood cell (WBC) count ≥5.9 × 109/l (OR = 2.31, 95% CI 1.12–4.77), moderate (OR = 4.87, 95% CI 1.61–14.78) or severe central venous stenosis (CVS) (OR = 4.74, 95% CI 1.16–19.38), and central venous thrombosis (CVT) (OR = 3.41, 95% CI 1.51–7.69) were associated with a significantly increased incidence of microbial colonization in a univariate analysis. Central venous disease (CVD) elevated the risk of microbial colonization, with an OR of 3.37 (1.47–7.71, P = 0.004). A multivariate analysis showed that both CVS and CVT were strongly associated with catheter microbial colonization, with ORs of 3.06 (1.20–7.78, P = 0.019) and 4.13 (1.21–14.05, P = 0.023), respectively. As the extent of stenosis increased, the relative risk of catheter microbial colonization also increased. In patients with moderate and severe stenosis, a sustained and significant increase in OR from 5.13 to 5.77 was observed.Conclusions: An elevated WBC count and CVD can put hemodialysis patients with TCCs at a higher risk of microbial colonization, even if these patients do not have the relevant symptoms of infection. Avoiding indwelling catheters is still the primary method for preventing CRI.

2021 ◽  
Vol 38 (02) ◽  
pp. 182-188
Author(s):  
Mari E. Tanaka ◽  
Oleksandra Kutsenko ◽  
Gloria Salazar

AbstractPelvic venous disease (PeVD) in women encompasses a wide variety of entities all resulting in pelvic pain and varices. Successful treatment with percutaneous interventions is dependent on identifying underlying factors contributing to the disease and addressing them with either embolization of incompetent veins or stenting for venous stenoses. There are a multitude of embolization methods with marked practice heterogeneity. Moreover, with the ongoing development of dedicated venous stents in the treatment of chronic venous disease, there are more opportunities to consider this modality for the treatment of PeVD, as many patients present with combined vein reflux and central venous stenosis. The necessity to address both and the order of interventions in these patients is still to be elucidated. Here, we describe when to choose stenting or embolization for PeVD, their limitations, and our practice and identify further areas of research in this field.


2019 ◽  
Vol 59 ◽  
pp. 225-230 ◽  
Author(s):  
Mina L. Boutrous ◽  
Alejandro C. Alvarez ◽  
Obi T. Okoye ◽  
Jennifer C. Laws ◽  
Donald L. Jacobs ◽  
...  

2019 ◽  
Vol 7 (3) ◽  
pp. 420-427
Author(s):  
Philip L. Auyang ◽  
Yusuf Chauhan ◽  
Thomas M. Loh ◽  
Matthew E. Bennett ◽  
Eric K. Peden

2020 ◽  
Vol Volume 16 ◽  
pp. 419-427
Author(s):  
Qusai Aljarrah ◽  
Mohammed Allouh ◽  
Amer Hussein Hallak ◽  
Shamikh E Alghezawi ◽  
Mamoon Al-Omari ◽  
...  

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