Background:

Access continues to be the most problematic aspect of dialysis treatment. Patients on maintenance hemodialysis had the highest risk of contracting a serious bloodstream infection that required admission to the intensive care unit. Central line-associated bloodstream infections (CLABSIs) are known as one of the major reason of hospital acquired infections, leading to life-threatening complications, reporting around 80 thousand cases per year from patients admitted in intensive care units, this number will raise dramatically if non ICU patients are also included. Mortality rate due to CLABSIs is reported as 25% of total infectious diseases mortalities.

Objective:

To evaluate the safe access for dialysis which can decrease the chances of infection and improve patient’s prognosis, secondary objective of the study is to document dialysis event.

Methodology:

Prospective, cross sectional, follow up, analytical study was conducted at the hemodialysis unit, of Tabba Kidney Institute, Karachi. Patients on maintenance hemodialysis, aged from 18 to 70 years, both gender, vascular access including non-cuffed, cuffed and Arterio-venous fistula were included in the study. Three types of dialysis events (DEs) according to canter of Disease and Prevention (CDC) were reported, Intravenous antimicrobial, Positive blood culture and Infection at the local vascular access site. Statistical package of social sciences (SPSS) version 22 was used, to enter, sort and analyse the data. The P-value of < 0.05 was considered as significant.

Results:

Total 72 patients completed the follow-up duration, mean age of study participants was 61.4 ± 13.3 years. Hypertension was most frequently reported comorbidity with 31 (43%) followed by diabetes mellitus. Vascular access was categorized as non-cuffed, cuffed and AVF groups with frequency of 27 (37.5%), 27 (37.5%) and 18 (25%) respectively.

In non-cuffed group, 9(12.5%) positive blood cultures, 6(8.3%) local site infection, 13 (18%) IV antimicrobial treatment and 19 (26.3%) total Dialysis events were documented. In Cuffed group, 4 (5.5%) positive blood culture, 3 (4.1%) local site infections, 9 (12.5%) IV antimicrobial treatment and 11 (15.2%) total dialysis events were documented. AVF group had no positive blood culture, 1 (1.3%) local site infection and 1 (1.3%) IV antimicrobial treatment and 1 (1.3%) total dialysis event were documented.

Conclusion:

Patients undergoing central venous catheterization are susceptible to a number of illnesses, including sepsis. However, the burden of these problems can be lessened with appropriate catheter insertion technique and cleaning. Furthermore, Patients who are undergoing for hemodialysis should be educated for better and permanent vascular access that is arterio-venous fistula (AVF).

Keywords:  Hemodialysis, Catheter, AVF, End stage renal disease, Mortality