Nutzung und Komplikationen getunnelter zentralvenöser Hämodialysekatheter
We retrospectively reviewed all hemodialysis catheters inserted in our institution between January 1992 and January 2003. All catheters were single lumen silicone catheters. 412 catheters were inserted in the internal iugular vein of 290 patients (143 men, 147 women; mean age 66 +/- 13 years). Mean indwelling time was170 +/- 10 days. At the end of follow-up, 5 patients were alive with a functioning catheter (1%), 93 patients (22%) died with a functioning catheter. A total of 319 catheters were removed. 188 (46%) because they were no longer needed, 64 (15%) because of dysfunction/thrombosis and 67 (16%) because of catheter-related infection. Patients with infection had higher serum creatinine levels (7,4 vs. 6,6 mg/dl, p< 0,05) and longer catheter indwelling times than patients without a infection (209 +/- 23 vs. 153 +/- 10 days, p< 0,05). However, serum albumin, serum protein, anaemia and frequency of diabetes did not differ between both groups. The incidence of catheter-related infection was 1.2 episodes/1000 catheter days. 78% of detected organisms were gram-positive, 20% gram-negative and in 2% fungi. Resistance to penicillins among gram-positive cocci rose from 46% between 1992 and 1996 to 55% between 1997 and 2003, to cepholosporins from 17% to 38%, to gyrase inhibitors from 23% to 41% and to aminoglycosides from 22% to 35%. Major complications of tunneled, cuffed central venous catheters are thrombosis and infection with a increase in resistance of causitive pathogens. Nevertheless, these catheters are a useful alternative vascular access in patients when other accesses are temporarily or permanently not available.
info:eu-repo/classification/ddc/610, Medizin, Hämodialyse, Bakterielle Infektion, Sekundärkrankheit, Resistenzbestimmung, Komplikation, Thrombose, Gefäßkatheter, hemodialysis, infection, comorbidity, antibiotic resistance, complication, thrombosis, centralvenous catheter
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