Bacteremia is the major complication of catheters in a hemodialysis patient. Most catheter related infections can be treated using in patient systemic antibiotics such as Vancomycin, Gentamicin, Ancef, and Fortaz. When in house treatment is not successful, complications can lead to endocarditis, osteomyelitis, septic arthritis, or epidural abscess. These infections require costly hospitalizations and procedures such as catheter exchanges which become detrimental to the patients health, especially if patients have other underlying diseases such as lupus, diabetes and HIV.
The predominant organisms related to catheter infections are coagulase-negative staphylococci, and staphylococcus aureus found on skin and nares. The hub of the catheter remains exposed and are handled by the patient, although advised against this, and medical personnel. This is where the bacteria migrate to the exit site or the lumens of the catheter. Uncovered exit sites are also exposed to patients or personnel positive for staph aureus in nares. These organisms have also developed resistance to antibiotics due to prolong use.
Catheters are locked at the end of treatment with heparin or sodium citrate 4% to preserve catheter patency. A few years ago infection rates were high in the chronic dialysis unit I was working at. University of Miami nephrologists conducted research studies on the use of prophylactic antibiotic catheter locks versus heparin locks to evaluate the rate of infections. My job was to record monthly infection rates for evaluation. Infection rates were reduced by 60% over a six month period. The problem was the costs of these antibiotics were high, and the side effects of the antibiotics over long time use were unknown without further research. The use of antibiotics as catheter locks was never implemented, although research outcomes were positive.
Stricter guidelines for cleaning catheters were implemented and only certain trained personnel could...