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Tunneled, cuffed hemodialysis catheter-related bacteremia

Michael Allon, MD
Daniel J Sexton, MD
Section Editor
Jeffrey S Berns, MD
Deputy Editors
Alice M Sheridan, MD
Kathryn A Collins, MD, PhD, FACS


Central venous catheters, originally introduced as vascular access for short-term dialysis, are occasionally used as a permanent vascular access. Both non-tunneled, non-cuffed catheters and tunneled, cuffed catheters are available. At present, tunneled, cuffed, double-lumen silastic catheters are the preferred access for short- and intermediate-term use in dialysis patients [1]. These catheters are also used for permanent vascular access in some patients, particularly those with limited alternative options for vascular access [1].

To a significant degree, the transition from non-tunneled catheters to tunneled, cuffed catheters has been driven by a change in preference for arteriovenous (AV) fistulas rather than AV grafts. Because fistulas require a much longer maturation time than grafts, the duration of catheter dependence for vascular access has increased substantially in hemodialysis patients [2]. In addition, a catheter is used for the initial dialysis session in approximately 80 percent of incident hemodialysis patients. (See "Overview of chronic hemodialysis vascular access".)

Tunneled, cuffed catheters are associated with a number of complications, particularly catheter-related bacteremia. The clinical impact of catheter-related bacteremia in hemodialysis patients has been quantified in several studies [3-6]. In the Hemodialysis (HEMO) study, for example, 7.6 percent of all patients had catheters used for vascular access, yet this group comprised 32 percent of all study patients hospitalized with access-related infection [6]. In another prospective study of 2666 Scottish patients on renal replacement therapy, use of a tunneled catheter for dialysis access was associated with a 6.9-fold higher odds of death from all causes and infection-related causes compared with patients using only AV fistulas or grafts for dialysis access [7]. Yet, despite these risks and international and national guidelines that recommend fistulas as the preferred form of dialysis access, the proportional use of tunneled catheters for dialysis access has steadily increased in many countries [8].

An overview of tunneled, cuffed dialysis catheter-related bacteremia is presented in this topic review. Other catheter-related complications, such as thrombosis, are discussed separately. (See "Thrombosis associated with chronic hemodialysis vascular catheters".)


Catheter-related bacteremia — The majority of bacteremias in hemodialysis patients are caused by infection of vascular access catheters. The incidence of bacteremia is greater in patients with indwelling tunneled catheters than in those with either fistulas or synthetic grafts [5,9]. The relative risk of tunneled dialysis catheters causing bacteremia in dialysis patients has been estimated to be approximately 10 times higher than the risk of bacteremia in patients with arteriovenous (AV) fistulas [10]. In addition, catheter-dependent hemodialysis patients have a two- to threefold higher risk of infection-related hospitalization and infection-related death as compared with patients undergoing dialysis via a fistula or graft [11,12].

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Literature review current through: Nov 2017. | This topic last updated: Jan 27, 2016.
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