Prevention of Hemodialysis Catheter Related Infection Using Uncuffed Catheter Restricted Filling with Gentamicin and Heparin for Chronic Hemodialysis Patients

Background : Catheter-related infection (CRI) is a major cause of morbidity and mortality in patients receiving hemodialysis. The antibiotic lock technique (ALT) has been recommended to prevent catheter-related infection. We have studied the use of gentamicin lock of catheters in combination with standard heparin to reduce CRI rates. Furthermore, we have investigated the effects of this strategy on catheter function. Objective : To compare gentamicin lock of catheter in combination with standard heparin lock of catheter alone for prevention of CRI and evaluation of catheter dysfunction in chronic hemodialysis patients. Design & Methods : A total of 30 hemodialysis patients requiring an uncuffed catheter while waiting for placement and maturation of an arteriovenous fistula or graft were screened, 12 patients were excluded, because of use of antibiotic or femoral catheter, 18 patients were studied. Patients were randomized to catheter-restricted filling with either standard heparin (5,000 IU/mL) alone, or gentamicin (4mg/mL) and heparin (5,000 IU/mL). Results : No infectious episode was developed in the gentamicin-locked group whereas one episode of exit site infection was developed in one patient in heparin-locked alone group. CRI rates were 2.35 episodes per 1,000 catheter-days, mean number of episodes/patient were 0.11+0.33 in heparin-locked alone group (P= 0.33). Catheter dysfunction was found in three patients in heparin-locked alone group but no dysfunction was found in the gentamicin-locked group. (P = 0.21) Conclusion : The practice of locking newly inserted uncuffed cathter with gentamicin, in combination with standard heparin, has trend to decrease catheter dysfunction. Because of small sample size, we can’t show statistically significant in reduce of CRI rate in the gentamicin-locked group. Further study with a larger number of patients needed to verify the effectiveness of this regimen.