Is it possible to reduce infectious complications in CVC for dialysis? If so, how?

Abstract

The number of patients using a central venous catheter (CVC) for hemodialysis is too high, being far above 10% also in Italy. There are several complications associated with CVC use, among which infectious events are the most important, since they are related with relevant morbidity and mortality. A recent meta-analysis, performed by Zhao, has shown that, considering the incidence of CVC-related infections, the citrate lock was better than heparin when used in association with antimicrobial agents (such as gentamicin or taurolidine) and at low to moderate concentration. Moreover, citrate use reduced bleeding episodes, while there were no differences in terms of exit-site infection and the use of thrombolytic treatment. Results from a recent comparative effectiveness evaluation using a prospective, cluster-randomized design have underlined the importance of an adequate care of CVC and exit-site. The use of 2% chlorhexidine with 70% alcohol swab sticks for exit-site care and 70% alcohol pads to perform “scrub the hub” resulted in a significant 20% lower rate of central line-associated infections compared to the controls; this was accompanied by a significantly lower need of antibiotic therapy and lower hospitalization rates for both sepsis and vascular access–related infections and complications. Either way, new trials and techniques are urgently needed to further improve the prognosis of patients performing hemodialysis using a CVC.