CRBSIS' IN TUNNELED CATHETERS- THE PRESENT DAY SCENARIO

Introduction:

Tunneled cuffed catheters (TCC) are one of the backbones of hemodialysis (‘a Necessary Evil’)– as they serve as a bridge to AV fistula creation or are the lifeline in patients with multiple access failure and poor vasculature. TCC although indispensable, have a higher chance of complications such as CRBSI, thrombosis and fibrin sheath formation, necessitating their removal. This study is a survival analysis for tunneled catheters being inserted.  

Methods:

1.Retrospective study of 174 patients who underwent tunnel catheter insertion/ had a previous tunnel catheter and underwent dialysis at our hospital in New Delhi from January 2022-July 2024.

2.Patient groups- Group A- those who underwent tunneled catheter insertion either at our center or elsewhere, but continued MHD at our center; Group B- those who underwent tunneled catheter insertion at our center but MHD elsewhere, followed up telephonically for catheter outcomes.  

3.CRBSI was defined as :- a. Definite: same organism grown from percutaneous blood culture and the catheter hub; b. Probable: positive blood cultures from a catheter and/or a peripheral vein in a symptomatic patient after excluding alternative sources of infection; c.Possible: when patients failed to get a culture or received empirical antibiotics before negative blood culture but no alternate explanation of a persistent febrile illness.

4.Intervention at our centre- Two technicians for dialysis initiation (one at patient side and one at machine side) and adhering to the ‘scrub-the-hub' protocol.  

Results:

A total of 174 patients were included, with 69% males, evaluated  for a total of 35291 catheter days . Overall, there were 37 CRBSI episodes in 35 patients(20.1%), with the incident CRBSI rate being 1.04 episodes per 1000 catheter days. We had 13 definite CRBSI episodes of which the most common organisms were gram negative organisms(11/13). The median time for catheter removal was 145(IQR,77-284) days. 8.6%(15) patients expired with a catheter in-situ, with 3.4%(6) of the deaths attributed to CRBSI. 8%(14) of the catheters were either removed for CRBSI/ other catheter related issues(poor flow/cuff extrusion, Table 1).

Upon subgroup analysis(Table.2) ,the CRBSI rates were lower among the patients’ undergoing dialysis at our centre(Group A).These patients also had better catheter survival (86.9% vs 71.4%) when censored for catheter removals for non CRBSI/catheter related reasons, however this was not statistically significant(p>0.05).

A Kaplan Meier curve for catheter survival censored for non-catheter related events, for 18months of follow up, showed better catheter survival rates in Group A compared to Group B(Figure 1).

Conclusions:

In conclusion, the overall CRBSI rates with TCC were notably low at 1.04 per 1000 catheter days, which is an improvement compared to previous Indian studies. Group A achieved an even lower CRBSI incidence of 0.90 per 1000 catheter days. This demonstrates that it is possible to achieve CRBSI rates of less than 1 per 1000 catheter days, similar to those in high-income countries, by adhering to higher standards of care with simple interventions— such as having two persons for starting and ending dialysis and following the 'scrub- the- hub' protocol before catheter use—for better outcomes.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.