Clinical Essentials | Risk Factors and Prevention of Catheter-Related Bloodstream Infection in Hemodialysis Patients

Catheter-related bloodstream infection (CRBSI) is one of the common complications in hemodialysis patients. Clarifying the risk factors for CRBSI in hemodialysis patients is not only important for preventing its occurrence, but also helps medical staff strengthen the management of high-risk groups such as hemodialysis patients.

1. Risk Factors

Meta-analysis in recent years has shown that six major aspects are risk factors for CRBSI in hemodialysis patients.

1. Basic diseases: Patients with diabetes, chronic lung disease, tumors, and neutropenia have a higher probability of infection. Compared with non-diabetic patients, the probability of infection in diabetic patients is 2.1 times higher.

2. Catheter indwelling time: The probability of central venous catheter infection is significantly related to the catheter indwelling time. The longer the catheter is indwelling, the greater the incidence of infection.

3. Age: Older people and women are more susceptible to infection. The incidence of catheter-related bacteremia in women aged >67 years is 38% within 9 months. Once infected, the mortality rate is even higher.

4. Hypoproteinemia: If hypoproteinemia occurs in patients with inadequate dialysis, it will cause severe gastrointestinal reactions, poor eating, uneven nutritional intake, etc., increasing the probability of infection.

5. Non-standard operation: Non-standard operation performed by medical staff (such as sealing method, aseptic operation) will increase the probability of infection, especially if nursing intervention is ≥4 times within 1 month and the number of catheterizations increases (especially femoral vein catheterization), which will further increase the probability of infection.

6. Other conditions: including but not limited to a history of catheter-related infection, central venous disease, problems with dialysis catheter materials, and conditions associated with catheter dysfunction or embolism.

2. Preventive measures

1. Before placing a catheter, medical staff should accurately assess the patient's vascular condition. For patients with poor vascular conditions, peritoneal dialysis can be used to minimize the use of semi-permanent catheters.

2. If hemodialysis treatment is performed on patients with poor vascular conditions, it is recommended to perform intravenous fistula anastomosis as early as possible, and then use central venous catheterization after the fistula matures for 3 to 4 months to relieve the patient's pain and reduce the risk of CRBSI.

3. For patients who need emergency dialysis treatment, intravenous fistula anastomosis can be performed at the same time as temporary catheterization to shorten the temporary catheterization time and reduce the risk of CRBSI.

4. Medical staff should strictly follow aseptic procedures, both during the catheterization process and in the catheter-related care after the catheterization.

5. During the catheterization period, medical staff should regularly evaluate the patient's catheterization status and infection risk, and closely observe the puncture site. If there is redness, swelling, pain, heat, and purulent secretions around the puncture site, it is recommended to collect the secretions for bacterial culture and drug sensitivity testing. Then, according to the patient's infectious pathogens and drug sensitivity test results, select appropriate antibacterial drugs.

6. Pay attention to details, such as maintaining an appropriate temperature in the ward and regularly testing the patient's partial thromboplastin time and prothrombin time in order to understand the patient's coagulation status.

7. Due to temperature and other reasons, patients are prone to sweating (especially in summer), so medical staff are advised to shorten the dressing change time. At the same time, it is necessary to observe whether the patient's body is damp to avoid sweating around the puncture point due to the strong viscosity of the anti-allergic dressing. Increasing the frequency of dressing changes can prevent patients from having local catheter infection as much as possible, thereby reducing the risk of CRBSI.

8. Medical staff should educate patients on the knowledge of catheterization so that they understand the importance and necessity of regular maintenance of the catheter. They should also instruct patients and their families on how to observe and care for the puncture site and communicate with doctors in a timely manner if any abnormal situation occurs.

9. Hospitals should improve their monitoring systems and use silicone hoses with strong resistance to bacterial adhesion. They should also regularly provide strict training on central venous catheterization for medical staff, standardize their related operations, and shorten the retention time of catheters.

3. Summary

In summary, central venous indwelling is a temporary vascular access in clinical practice. Although it has the advantages of less trauma, effectiveness, safety, low cost, and simple operation, it is prone to CRBSI, which seriously affects the implementation of the operation and may also increase the mortality rate of patients. Therefore, it is extremely important to understand the risk factors of dialysis catheter-related bloodstream infection and strengthen the prevention and control of CRBSI.