Early-Cannulation Arteriovenous Grafts Are Safe and Effective in Avoiding Recurrent Tunneled Central Catheter Infection.

Abstract

OBJECTIVES:

Tunneled central venous catheter infection (TCVCi) is a common complication that often necessitates removal of the TCVC and replacement by a further TCVC. Theoretically, insertion of an early - cannulation graft (ecAVG) early after TCVC infection is possible but not widely practiced with concerns over safety and infection in the ecAVG. With 8 years of ecAVG experience, the aim of this study was to compare the outcomes following TCVC infection, comparing replacement with TCVC (TCVCr) versus immediate ecAVG (ecAVGr).

DESIGN:

Retrospective comparison of 2 cohorts, who underwent replacement of an infected TCVC either by an early cannulation graft (n = 18) or by a further central catheter (n = 39).

METHODS:

Data were abstracted from a prospectively completed electronic patient record and collected on patient demographics, TCVC insertion, duration and infection, including culture proven bacteriaemia and subsequent access interventions.

RESULTS:

Eighteen of 299 patients identified from 2012 to 2020 had an ecAVG implanted as treatment for a TCVCi. In a 1-year time-period (January 1, 2015-December 31, 2015) out of 222 TCVC inserted, 39 were as a replacement following a TCVCi. No patient with an ecAVGr developed an immediate infection, nor complication from the procedure. The rate of subsequent vascular access infection was significantly more frequent for those with a TCVCr than with an ecAVGr (0.6 vs. 0.1/patient/1000 HD days, P< 0.000). The number of further TCVC required was significantly higher in the TCVCr group (7.1 vs. 0.4/patient/1000 HD days, P= 0.000).

CONCLUSIONS:

An ecAVG early following a TCVC infection is safe, reduces the incidence of subsequent infectious complications and reduces the number of TCVC required, with a better functional patency.

• Authors: S Richarz, K Stevenson, B White, P C Thomson, A Jackson, A Isaak, D B Kingsmore
• Journal: Annals of vascular surgery (Ann Vasc Surg) Vol. 75 Pg. 287-293 (Aug 2021) ISSN: 1615-5947 [Electronic] Netherlands
• PMID: 33819582 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• Arteriovenous Shunt, Surgical (adverse effects)
• Catheter-Related Infections (diagnosis, microbiology, prevention & control)
• Catheterization
• Catheterization, Central Venous (adverse effects, instrumentation)
• Catheters, Indwelling (adverse effects)
• Central Venous Catheters (adverse effects)
• Device Removal
• Female
• Humans
• Male
• Middle Aged
• Reinfection
• Renal Dialysis
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Time Factors
• Treatment Outcome