An efficient strategy to decrease the central venous catheter-related adverse events rate in haemodialysis patients

Introduction. - Catheter-related adverse events (CAE) remain a major cause of mortality and morbidity. Aim. - We aimed to compare the CAE prevalence and adverse events rate at 10 years interval in one centre using different devices, dressing procedures. Methods. - We compared two periods, from 1994 to 1997 (period 1) and from 2004 to 2007 (period 2). We recorded all prevalent tunnelled CAE and their related adverse event rate: catheter-related bacteraemia (CRB), catheter local infection (CLI), catheter dysfunction leading to CAE exchange, thrombolytic use and spontaneous putting up. Results. In period 1, PermCath(R) catheter (Quinton, N = 63) and TwinCath(R) catheter (MedComp, N 76) were used in 95 HID. BioFlex(R) catheter (N = 52) and ASPC split catheter (MedComp, N = 52) were used in 72 HID in period 2. In period 1, we performed catheter dressing using povidone iodine versus alcoholic chlorexidine in period 2. Between period 1 and period 2, the CAE prevalence decreased from 15-18% to 9-6%, CRIB from 1.1 to 0.23/1000 day-catheter (p < 0.001), CLI from 1.1 to 0.28/1000 day-catheter (p < 0.001), definitive dysfunction from 12 to 1.2% (p < 0.001) and CAE putting up from 4 to 0%. The annual urokinase consumption decreased from three to one unit per CAE. Conclusion. - This study shows the dramatic decrease in CAE prevalence (-50%) and related-adverse events (approximate to-200%) since 10 years. Switching povidone iodine to chlorexidine and using more recent catheter devices appear very efficient in decreasing catheter-related adverse events. (C) 2009 Association Societe de nephrologie. Published by Elsevier Masson SAS. All rights reserved.