Risk Factors of Catheter-Related Infection in Patients Undergoing Hemodialysis Using Double Lumen Catheter at Dr. M. Djamil Hospital Padang

Background. Chronic kidney disease (CKD) is a terminal disease requiring hemodialysis. Hemodialysis requires vascular access using a double lumen catheter (DLC). However, the use of DLC may increase complications mainly infection, either infection of exit site or bloodstream. This study is aimed to seek risk factors contributing to the incidence of central catheter-related infections in CKD patients with DLC undergoing HD at Dr. M. Djamil Hospital, Padang. Methods. This study is a prospective study on patients undergoing HD at Dr. M. Djamil Hospital, Padang. This study using consecutive sampling technique. Data were analyzed using SPSS version 25.0. Results. This study involved 40 CKD patients undergoing HD. Majority of the samples had bloodstream infections (67.5%). Clinical manifestations of purulent secretion, duration of catheter used, and hypoalbuminemia had significant differences in the incidence of DLC infection based on bloodstream infection and exit site infection (p<0.05). The most common bacterial found was Pseudomonas aeruginosa (22.5%) which was sensitive to ceftazidime, cefepime, meropenem, amikacin, gentamicin, ciprofloxacin. Conclusion. Factors contributing to the incidence of DLC-related infections at Dr. M. Djamil Hospital are duration of catheter use and hypoalbuminemia. Pseudomonas aeruginosa is the most common cause of DLC-related infections.

Active Cerebrospinal Fluid Exchange System for Treatment of Pyogenic Ventriculitis

ABSTRACT BACKGROUND Despite recent advances in antibiotic treatment, pyogenic ventricular brain infections are still associated with adverse clinical outcome in 80% of affected patients and mortality rates approaching 60%. The limitation of antibiotic penetration into the cerebrospinal fluid (CSF) challenges the treatment. Intrathecal treatment remains an option for adjunctive therapy to intravenous (iv) antibiotics when the iv therapy fails to sterilize the CFS. Current treatment options do not allow for changing the CSF composition without adversely affecting intracranial pressure (ICP) and power of hydrogen (pH). OBJECTIVE To investigate if CSF composition exchange has impact on ventriculitis patients. METHODS We report 2 cases with pyogenic ventriculitis treated with a new intracranial active fluid exchange system that consists of a dual-lumen catheter to facilitate irrigation and drainage coupled with an intelligent digital pump. RESULTS This new technique allowed us to change the composition of CSF to an antibiotic-consisted fluid. This resulted in the ability to directly modify the concentration of the targeted antibiotics in the CSF, while simultaneously removing bacterial mass without harming brain tissue and controlling ICP and pH. CONCLUSION Our reported experience shows that drainage of purulent fluid caused by healthcare-associated ventriculitis or meningitis is now possible without harming brain tissue and ICP while also changing the composition of CSF to an antibiotic-consisted fluid. Actively removing pus and altering CSF in this manner had an impact on infection treatment and antibiotic penetration. Further cases are needed to confirm that our treatment algorithm is correctly tailored to assist clinicians in reliably treating this catastrophic condition.

Line Thrombosis in Patient on Maintenance Hemodialysis with use of Trisodium Citrate 4% V/S Heparin at Sheikh Zayed Hospital Rahim Yar Khan

Background: Conventional Heparin and Tri-sodium citrate 4% are used for locking double lumen catheter after dialysis to prevent line thrombosis. Objectives: To compare the line thrombosis after use of heparin and tri-sodium citrate 4%. Methodology: Randomized controlled trial study involving patient who develop line thrombosis after use of heparin and tri-sodium citrate 4% from February 2020 to August 2020. The study was done on a group of 200 patients who had poor blood flow in double lumen catheter during dialysis. After informed consent first detailed clinical history was taken from patient. Inclusion criteria waspatient of age 14 year of above either gender who presented with renal failure, whom dialysis was performed via temporary catheter or permanent catheter. Conventional heparin and tri-sodium citrate are used as line blocking agents and line thrombosis was observed in patients. The data was entered and analyzed SPSS 20. Results: During this research work 200 double lumen were paced in patients. Out of these, in 100 patients heparin was used as locking solution and locking period was 45-60 days. In remaining 100 patients tri-sodium citrate was used as locking solution in the locking period was 45-60 days. There was no difference in patient’s comorbid conditions in both groups of the patients (Figure1). The catheter change rate was greater in patients whose catheter were locked with heparin (52 patients) as compared to tri-sodium citrate (42 patients). The proportion of the patient who needs replacement of the double lumen were 81% in conventional heparin sulphate and 65% with 4% tri-sodium citrate groups. There was longer insertion time for requiring double lumen for line thrombosis related poor blood flow in patients in which 4% tri-sodium citrate were used for catheter locked with comparison to the group in which heparin sulphate were used for locking (Figure2). The average hospitalization for line related thrombosis was longer in heparin group (10.5 days) as compared to citrate group 3.2 days. (P=0.02) The hospitalization rate was 6% in heparin group as compared to 2.5% in tri-sodium citrate group (P=045%). Conclusion: Tri-sodium citrate 4% is equally effective cheap and beneficial with comparison to heparin sulphate. It showed good outcome as far as change of double lumen or double lumen related infection or hospital admission when compared with heparin sulphate. Randomized trials while using tri-sodium citrate with other anti-coagulant would definitely will decide the better double lumen catheter locking agent. Key Words: End stage kidney failure, Advanced renal disease, Dialysis, double lumen blood flow.

BACTERIAL SPECTRUM AND ANTIMICROBIAL PATTERN OF BLOOD STREAM INFECTIONS ASSOCIATED WITH NON-TUNNELED DOUBLE LUMEN CATHETER IN HEMODIALYSIS PATIENTS

Objective: To assess Bacterial spectrum and antimicrobial pattern of Blood Stream Infections associated with non-tunneled double lumen catheter in hemodialysis patients. Study Design: Prospective observational study. Place and Duration of Study: Department of Nephrology, Pakistan Emirates Military Hospital Rawalpindi Pakistan; Armed Forces Institute of Pathology Rawalpindi, Pakistan, from May 2019 to Apr 2020. Methodology: A total of 753 patients underwent placement of non-tunneled double lumen catheter (457 femoral, 296 Internal Jugular). Patients with clinically suspected bloodstream infections had their catheters removed with tips being sent for culture along with 2 sets of peripheral blood cultures. Patients were labelled as having bloodstream infection if growth of organism was detected in catheter tip and at least one peripheral blood culture. Susceptibility testing was done for available antimicrobials. Results: One hundred and thirty six (18.06%) incidences or 5.48 bloodstream infections per 1000 catheter days, with confirmed growth on blood cultures were identified. Gram positive infections were seen in 76 (55.88%) individuals with most common organism being coagulase-negative Staphylococcus (28.68%), followed by Staphylococcus aureus (21.32%). These organisms had low resistance rates to Vancomycin (0%), Tigecycline (0%), Doxycycline (6.6%) and Linezolid (9.5%). Gram negative infections were seen in 60 (44.11%) patients with Klebsiella pneumoniae (13.24%) being the most commonly identified pathogen followed by Acinetobacter baumannii (12.50%) and had relatively higher degree of antimicrobial resistance. Conclusion: Gram positive organisms were the most common cause of bloodstream infection in this study and were found susceptible to vancomycin and doxycycline whereas gram-negative organisms had high rates of antimicrobial......

Incidence And Characteristics Of Double Lumen Induced Central Venous Catheter-Related Thromboembolism In Hemodialytic Patients

<p><strong>Background: </strong>Central venous catheters (CVCs) are frequently used in patients for several indications such as cancer treatment, diagnostic monitoring, parenteral nutrition, hemodialysis, and administration of fluids, blood products or medication. Double lumen catheter induced CVCs thrombosis has not been paid into proper attention in developing countries such as Indonesia.</p><p><strong>Aims:</strong> The aim of this study is to identify the incidence and characteristic of double lumen catheter induced CVCs thrombosis in patients undergoing hemodialysis.</p><p><strong>Methods: </strong>This systematic review has been registered in PROSPERO (CRD42020181584). A systematic search of literature for observational and randomized controlled trial was conducted in PubMed, PubMed central, and Google Scholar through April 16, 2020. Two reviewers independently searched and selected. The risk of bias was evaluated using the Newcastle-Ottawa Quality assessment tool.<strong> </strong></p><p><strong>Results: </strong>A total of 408 patients were included in our study. There were 192 (47.1%) male patients. The double lumen catheter was mostly placed in the jugular vein (60%), followed by subclavian vein (25%) and femoral vein (15%). Four (1.1%) patients had deep vein thrombosis after about one month of double lumen catheter placement. All these four patients, the double lumen catheter was inserted in the femoral vein. Any other significant risk factors for thrombosis other than double lumen catheter insertion not found. Out of these four patients, one of them passed away. All patients were treated using heparin.</p><p><strong>Conclusion: </strong>The incidence of double lumen catheter induced thrombosis is low (1.1%) in patients undergoing hemodialysis. However, further larger study is needed to confirm and find the associating factors.</p>

Development of a Subpath Extrusion Tip and Die for Peripheral Inserted Central Catheter Shaft with Multi Lumen

The tip and die for manufacturing multi-lumen catheter tubes should be designed considering the flow velocity of the molten polymer and the deformation of the final extruded tube. In this study, to manufacture non-circular double-lumen tubes for peripherally inserted central catheters (PICCs), three types of tip and die structures are proposed. The velocity field and swelling effect when the circular tip and die (CTD) are applied, which is the commonly used tip and die structure, are analyzed through numerical calculation. To resolve the wall and rib thickness and ovality issues, the ellipse tip and die (ETD) and sub-path tip and die (STD) were proposed. In addition, based on the results of numerical analysis, the tip and die structures were manufactured and used to perform extrusion. Finally, we manufactured tubes that satisfied the target diameter, ovality, wall, and rib thickness using the newly proposed STD.

Net Drainage as a Novel Metric for Irrigating Drainage Systems in Chronic Subdural Hematoma Management: A Case Report

BACKGROUND AND IMPORTANCE Chronic subdural hematoma (cSDH) is a common neurosurgical pathology with a projected increase in prevalence as the elderly population grows. Traditional treatment for cSDH involves burr hole drainage or craniotomy with or without a subdural drain. This case describes a novel irrigation and drainage protocol using IRRAflow dual-lumen catheter system that utilizes early irrigation and measurement of the net fluid output to improve postoperative outcomes. CLINICAL PRESENTATION A 75-yr-old male presented to the emergency department with 2 wk of progressive dizziness, headache, confusion, and left-sided weakness over the past week. Computed tomography (CT) of the head showed 25-mm-thick, right-sided cSDH with 7 mm of right-to-left midline shift. The patient was taken to the operating room for right-sided craniotomy for subdural hematoma evacuation with placement of IRRAflow irrigating drain in the subdural space. The IRRAflow drain irrigated at 100 cc/h for 23 h with net output consistently greater than irrigation rate. Head CT the following day showed a progressive decrease in subdural collection. The patient was discharged on postoperative day 2 and had complete resolution of his neurological symptoms by postoperative day 11. CONCLUSION As cSDHs become more prevalent in the aging population, development of improved management strategies is imperative. This report describes the use of an IRRAflow dual-lumen catheter with a novel protocol consisting of a high rate of irrigation but net fluid output, which led to rapid recovery and resolution of neurological deficits in a patient with a cSDH.

Determinan kejadian pemasangan ulang double lumen catheter pada pasien dengan penyakit ginjal kronis

Determinants of double lumen catheter reimplantation in patients with chronic kidney diseaseBackground: Double Lumen catheter is a sterile tube that is inserted into a large central vein such as the jugular vein, subclavian vein or femoral vein through a surgical procedure. Failure of hemodialysis due to positional dysfunction and double lumen catheter infection must be reimplanted so that the hemodialysis continues on schedule.Purpose: To determine the relationship of factors that affect reattachment of the double lumen catheter in patients with chronic renal failure in BSD Medika Hospital.Method: A descriptive quantitative analytic with cross sectional design. Subjects were chronic kidney disease patients who performed regular hemodialysis through double lumen hemodialysis catheter access. Risk factor variables (age, sex, hypertension, DM, history of infection, location of insertion, duration of use, history of previous double lumen catheter placement). The research sample was 32 respondents.Results: Bivariat results, age (p = 0.637); gender (p = 1.000); status of hypertension (p = 0.338); status of infection (p = 0.138); status of Diabetes Mellitus (p = 0.053); insertion location (p = 0.052); duration of use (p= 0.004).Conclusion: There is a significant correlation between duration of use and reimplantation of double lumen catheter in patients with chronic kidney disease.Keywords: Double lumen catheter; Reimplantation; Patients; Chronic kidney diseasePendahuluan: Double lumen catheter adalah suatu selang steril yang dimasukan kedalam vena sentral besar seperti vena jugularis, vena subklavia atau vena femoralis melalui prosedur operasi. Kegagalan hemodialisa yang dikarenakan disfungsi posisi dan infeksi double lumen catheter maka harus dilakukan pemasangan ulang kateter agar hemodialisa tetap dilaksanakan sesuai jadwal.Tujuan: Mengetahui adanya hubungan faktor-faktor yang memengaruhi pemasangan ulang double lumen catheter pada pasien penyakit ginjal kronik di RS Medika BSD.Metode: Penelitian deskriptif analitik kuantitatif dengan desain cross sectional. Variabel yang digunakan adalah usia, jenis kelamin, riwayat hipertensi, riwayat DM, riwayat infeksi, lokasi insersi, lama penggunaan, dan riwayat pemasangan double lumen catheter sebelumnya. Subyek penelitian adalah pasien dengan penyakit ginjal kronis yang dilakukan hemodialisis reguler melalui akses vaskular kateter hemodialisis double lumen. Sampel penelitian sebesar 32 responden.Hasil: bivariat analisis menunjukkan hasil: usia (p=0.637); jenis kelamin (p=1.000); riwayat hipertensi (p=0.338); riwayat infeksi (p=0.138); riwayat DM (p=0.053); lokasi insersi (p=0.052); dan lama penggunaan (p=0.004).Simpulan: Lama penggunaan berhubungan signitifikan dengan pemasangan ulang catheter double lumen pada pasien gagal ginjal kronik di RS Medika BSD Kota Tangerang Selatan.