Background: Hemodialysis (HD) is most common form of renal replacement therapy available for patients with end stage renal disease in India. The most common vascular access used in patients initiating HD in India is non-cuffed catheter. However, it has significant infective complications.
Objective: To compare effect of two different catheter lock solution i.e. Heparin (H) versus heparin plus gentamicin (HG) lock on catheter lifespan and incidence of dialysis catheter related blood stream infections (CRBSI).
Materials and methods: This is a single centre prospective randomized controlled study conducted at tertiary care hospital from February 2017 to August 2018. All patients with end stage renal disease initiating dialysis via non- tunnelled and non-cuffed catheter were screened for enrolment. 47 eligible patients were randomized into two groups. Control group (H) received standard lock with Heparin. HG group received lock with heparin plus Gentamicin. Catheter lifespan and catheter related blood stream infection (CRBSI) rate in the two groups was compared. In those who developed CRBSI, catheter was removed if fever persisted for 2 days despite empirical antibiotic therapy or blood flow during dialysis was persistently less than 200ml/min. Blood culture and catheter tip culture, if catheter was removed was done for suspected CRBSI. Culture and sensitivity pattern was noted.
Results: 109 patients were screened. 47 participants satisfied the eligibility criteria and were included in the study. Average catheter duration was 40.62 ± 7.89 days. Overall the cumulative incidences of CRBSI at the end of the study period were 5.76 events per 1000 catheter-days. 11 (23.4%) patients developed catheter related infection during the study. Incidence of CRBSI in control (H) group was 7.97 events per 1000 catheter-days versus 3.88 events per 1000 catheter-days in HG group. Catheter lifespan in H and HG group was 38.17 ± 7.15 days and 42.96 ± 7.99 days respectively (p= 0.036). 4 out of 24 patients in HG group developed growth of organisms in contrast to 7 out of 23 in H lock group.
Conclusions: Use of Gentamicin plus heparin lock solution in non-tunelled non-cuffed HD catheter as compared to standard Heparin lock alone decreases the rate of catheter related blood stream infection and a modest but statistically significant increase in catheter lifespan.
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2022: 6.012
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