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Central Venous Catheters for Dialysis (CVCDs)

Catheter Related Bloodstream Infection (CRBSI)

Addressing the complications of catheter-related bloodstream infections (CRBSI), biofilm development and poor blood flow from the use of central venous catheters (CVCs) is no simple task. These complications are often associated with higher patient morbidity and mortality rates as well as significant financial implications due to more frequent use of costly medications and/or procedures as well as hospitalizations.

It is a common practice in both the acute and chronic settings to flush or "lock" CVCs with saline and heparin to help prevent the development of clots, blockages and sheaths. There are currently no FDA approved prophylactic, injectable therapies with properties that address the growing incidence of bacterial infections and biofilm development.

Both the NKF and CDC guidelines recommend the following approaches for addressing the complication of CRBSI:

  • Enhanced sterile technique by caregivers and patients is imperative
  • Use of IV antibiotics for the treatment of a diagnosed CRBSI
  • Combination antibiotic and heparin catheter injection for short term duration once a patient has been diagnosed and treated for their CRBSI

In the event of catheter patency failures it is recommended that the medical professionals providing care perform all or a combination of the following interventions:

  • Dissolve the existing thrombosis or clot with the use of antithrombolytics such as tPA.
  • Mechanically “declot” the catheter with a radiological brushing procedure
  • Extend the dialysis session (compromising the machine’s efficiency) in order to address the patient’s needs

If the above mentioned procedures and medications fail to address the frequent complications (CRBSI, biofilm development or poor blood flow) associated with CVCs it is highly likely that the patient’s catheter will eventually need to be removed and replaced.