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Central Venous Catheters for Dialysis (CVCDs)

Catheter Related Bloodstream Infection (CRBSI)

The use of central venous catheters (CVCs) either in chronic or acute care settings are not without their challenges.  The most frequently reported complications associated with CVCs are the high incidence of catheter-related bloodstream infections (CRBSI), development of biofilm on the catheter wall surfaces and poor blood flow rates as a result of clotting, blockages and sheaths.  The failure rates of central venous catheters as a result of these complications are significant and quite often require the removal of the catheter prematurely.

Failure Rates of Catheters & Ports Due to CRBSI*

Non-tunneled catheters (acute)

16.5% / month

66.1% / 6 months

Tunneled catheters (long term)

10.0% / month

46.9% / 6 months

PICC lines

6.5% / month

33.2% / 6 months

Implantable ports

3.3% / month

18.2% / 6 months

*Source: Calculated from data by Alan D. Tice, MD, FACP, Infections Limited, University of Washington

The most common causes of CRBSI are:

  • Intraluminal bacterial migration from contaminated catheter hubs
  • Intraluminal bacterial growth in biofilm on the surface of the catheter walls
  • Migration of bacteria throughout the bloodstream exposing all cells
  • Both gram positive (65%) and gram negative (35%) bacteria are present in CRBSI infections in dialysis patients

A major contributor to the rising incidence and reoccurrence of CRBSI is the development of biofilm on catheter surfaces. Microbial biofilm develops when microorganisms irreversibly adhere to catheter surfaces and produce extra-cellular polymers that facilitate adhesion and provide a structural matrix for growth. Biofilm-associated microorganisms behave differently from planktonic (freely suspended) organisms with respect to their growth rates as well as their ability to resist antimicrobial treatments such as antibiotics. The eradication of biofilm with today’s therapeutic options is nearly impossible. As a result, the development of biofilm in a CVC is a near certainty. Not only does it promote the growth of bacteria, it plays a significant role in the escalating antibiotic resistance rates and high morbidity and mortality of patients who develop CRBSI.

In addition to the development of biofilm and the high incidence of CRBSI, another common complication of CVCs is poor blood flow (patency) rates.  According to the National Kidney Foundations KDOQI Guidelines sufficient blood rates for a CBCD are defined as 300 mL/min., however, most healthcare professionals would view this as a minimum and are more realistically targeting 400 mL/min. Attaining these flow rates for long periods is nearly impossible with current catheter designs.

The most common causes of poor catheter blood flow (patency): 

  • Blockages form within the lumen
  • Clotting at the tip of the catheter
  • Development of fibrous sheaths (“bio sheath”) outside the flow passages (small holes in the catheter lumen) and in the tip of the catheter