The Biggest Fear Of Dialysis Catheters Is Infection. Learn About Dialysis CVC-related Bloodstream Infections in This Article

Hemodialysis is the main method of renal replacement therapy for patients with end-stage renal disease, and autologous arteriovenous fistulas are the first choice for vascular access. Central venous catheter (CVC) is also the last lifeline for hemodialysis patients. With the advancement of medical concepts, the shift from "fistula first" to "patient-centered" is gradually changing. Therefore, the optimal solution for patients is not necessarily autologous. Arteriovenous fistula.

Click to Cistanche for kidney disease

As the number of dialysis patients increases year by year, the duration of dialysis is extended, and the population ages, the utilization rate of CVC among hemodialysis patients is gradually increasing. Catheter-related complications, especially catheter-related bloodstream infections (CRBSI), are very harmful to patients, and in severe cases threaten the patient's life safety, which has attracted increasing attention.

Infection is one of the more serious complications of hemodialysis currently known. It not only causes the patient's condition to worsen but also easily induces other complications and leads to the patient's death. The main causes of death in maintenance hemodialysis patients are cardiovascular disease, infection, and cerebrovascular accidents. Infection is the second cause of death in maintenance hemodialysis patients. Therefore, it is extremely important to correctly understand the risk factors of hemodialysis catheter infection and to actively prevent it.

01 Clinical manifestations and diagnosis

A few minutes to 10 minutes after the start of hemodialysis, the patient develops systemic symptoms such as chills, chills, and fever, which are typical manifestations of hemodialysis catheter infection.

A small number of patients may develop delayed fever, that is, low-grade fever after hemodialysis, which is related to the number and virulence of the infected bacteria. When a patient develops these symptoms, blood culture specimens need to be collected to confirm the diagnosis and guide the next treatment.

The diagnosis of hemodialysis catheter-related bloodstream infection requires the collection of peripheral blood culture specimens, and the culture results of the blood specimens drawn directly from the hemodialysis catheter port are required to be the same as those of the peripheral blood samples, and the number of bacteria is more than three times that of the peripheral samples; The culture results of directly drawn blood culture specimens are the same as those of peripheral blood specimens, and the positive culture alarm time is at least 2 hours earlier than that of peripheral specimens; or the same bacteria as those of peripheral blood specimens are cultured on the tip of the catheter (the catheter needs to be removed).

02 Specialist analysis of causes of catheter-related infections

1 Patient factors

During hemodialysis treatment, a small amount of protein is lost during the process of removing toxins from the patient's body. Elderly dialysis patients have reduced digestive function and reduced intake of protein, vitamins, dietary fiber, etc., leading to malnutrition and low body resistance. Especially patients with diabetes have a higher risk of infection than the general population due to disorders of glucose metabolism, low immune function, and reduced defense function. Older age, hypoalbuminemia, low hemoglobin levels, malnutrition, diabetes, and use of immunosuppressants are risk factors for hemodialysis catheter infection.

2 Catheter-related factors

Colonization of the patient's local skin flora and invasive catheterization operations can increase the risk of dialysis central venous catheter infection. Because the catheterization physician is not skilled in catheter placement and repeatedly punctures, pathogenic bacteria can invade deep parts through the puncture needle, and repeated punctures will also Cause severe local irritation and damage and increase the risk of infection. The location and duration of central venous catheter indwelling are closely related to catheter infection. Theoretically speaking, the skin of the femoral vein has deep folds and is close to the perineum. The surrounding skin has more parasites and is easily contaminated by excreta, which puts the risk of infection at a greater risk. The "Chinese Expert Consensus on Vascular Access for Hemodialysis (2nd Edition)" recommends the order of catheter selection: right internal jugular vein, left internal jugular vein, right femoral vein, left femoral vein, and subclavian vein.

3. Medical factors

The air cleanliness of the operating environment, air exposure time at the catheter port, hand hygiene, and aseptic operation performance will affect the occurrence of catheter-related infections. Hemodialysis centers are outpatient treatment environments with intensive personnel flow. Dynamic conditions, including any personnel sorting items, frequently opening doors, moving around, performing cleaning work, etc., will increase the number of floating bacteria in the air. If the catheter opening is exposed to the air for too long, bacteria may contaminate the catheter through sedimentation or pass through the opening. Enter the body and cause catheter-related infections.

03 Catheter care measures during dialysis

1. Disinfection of the catheter port when getting on and off the machine

During the use of central venous catheters for hemodialysis treatment, appropriate catheter disinfection methods can effectively prevent and control catheter infections. Repeated disinfection of the outer wall of the catheter and the catheter port when getting on the machine, wrapping the catheter connection with disinfectant gauze during the dialysis process, and disinfecting the catheter port again when sealing the tube when getting off the machine can effectively reduce the occurrence of catheter infection. The arteriovenous connector of the catheter should be disinfected with iodophor/ameriodine/chlorhexidine or other disinfectants.

2. Care of the outer port of the hemodialysis catheter

Applying antibacterial ointment to the catheter outlet can reduce the risk of dialysis tube infection, especially mupirocin ointment, which is the most studied. However, considering the resistance problem of long-term application of antibacterial ointment, some guidelines recommend short-term application of antibacterial ointment to prevent infection before the exit site matures after surgery, but do not recommend long-term application after the exit site matures. It is recommended that the catheter outlet be covered with sterile dry gauze or other breathable dressing. Prevention of infections related to hemodialysis catheters is important. Medical staff should minimize the use of CVC, pay attention to hand hygiene, and perform strict aseptic procedures.

3. Application of tube sealing liquid after removal from the machine

There have been many studies on the preventive use of antibiotic tube closure in recent years, involving drugs such as gentamicin, vancomycin, linezolid, cefazolin, and cefotaxime sodium. Although most studies have observed that antibiotic lockout can reduce the incidence of bloodstream infections in the short term (mostly within 6 months) compared with heparin lockout alone, the risk of bacterial resistance brought about by long-term antibiotic lockout cannot be ignored.

Regarding the selection of other non-antibiotic lock solutions, citric acid and ethylenediaminetetraacetic acid at low to medium concentrations alone are not considered superior to heparin. High-concentration saline sealing is another type of sealing solution that has been studied in recent years. There is no difference in the incidence of infection from heparin sealing. However, in vitro experiments with hypertonic saline have shown antibacterial effects against G-bacteria. For patients at risk of bleeding, hypertonic saline can be an option as a catheter lock solution. Regarding the concentration of heparin locking solution, different studies have different results. Compared with high-concentration heparin (≥5000U/ml), low-concentration heparin (<5000U/ml) does not affect the patency of CVC and can reduce blood flow. infection risk

4. Comprehensive management measures

All measures cannot replace the strict aseptic operation and disinfection and isolation techniques of medical staff. Wet disinfect and wipe the floor between dialysis sessions, use air purification and disinfection equipment, and reduce the flow of personnel during dialysis (especially during getting on and off the machine) to avoid increasing the risk of dialysis central venous catheter infection due to air quality. Healthcare workers need to strictly observe hand hygiene, and wear masks and gloves when handling catheters, and patients should also wear masks. Strictly disinfect the catheter port when it is put on the machine to avoid and reduce the long-term exposure of the open catheter to the air. The outlet of the catheter without inflammation can be cleaned with saline, and the outlet of the catheter with secretions can be cleaned with disinfectant. In addition, patients should be educated to pay attention to daily cleaning, and properly fix and protect the catheter to avoid traction damage.

How Does Cistanche Treat Kidney Disease?

Cistanche is a traditional Chinese herbal medicine used for centuries to treat various health conditions, including kidney disease. It is derived from the dried stems of Cistanche deserticola, a plant native to the deserts of China and Mongolia. The main active components of cistanche are phenylethanoid glycosides, echinacoside, and acteoside, which have been found to have beneficial effects on kidney health.

Kidney disease, also known as renal disease, refers to a condition in which the kidneys are not functioning properly. This can result in a buildup of waste products and toxins in the body, leading to various symptoms and complications. Cistanche may help treat kidney disease ase through several mechanisms.

Firstly, cistanche has been found to have diuretic properties, meaning it can increase urine production and help eliminate waste products from the body. This can help relieve the burden on the kidneys and prevent the buildup of toxins. By promoting diuresis, cistanche may also help Reduce high blood pressure, a common complication of kidney disease.

Moreover, cistanche has been shown to have antioxidant effects. Oxidative stress, caused by an imbalance between the production of free radicals and the body's antioxidant defenses, plays a key role in the progression of kidney disease. ies help neutralize free radicals and reduce Oxidative stress, thereby protecting the kidneys from damage. The phenylethanoid glycosides found in cistanche have been particularly effective in scavenging free radicals and inhibiting lipid peroxidation.

Additionally, cistanche has been found to have anti-inflammatory effects. Inflammation is another key factor in the development and progression of kidney disease. Cistanche's anti-inflammatory properties help reduce the production of pro-inflammatory cytokines and inhibit the activation of inflammation mandatory pathways, thus alleviating inflammation in the kidneys.

Furthermore, cistanche has been shown to have immunomodulatory effects. In kidney disease, the immune system can be dysregulated, leading to excessive inflammation and tissue damage. Cistanche helps regulate the immune response by modulating the production and activity of immune cells, such as T cells and macrophages. This immune regulation helps reduce inflammation and prevent further damage to the kidneys.

Moreover, cistanche has been found to improve renal function by promoting the regeneration of renal tubes with cells. Renal tubular epithelial cells play a crucial role in the filtration and reabsorption of waste products and electrolytes. In kidney disease, these cells can be damaged, leading to damaged renal function. Cistanche's ability to promote the regeneration of these cells helps restore proper renal function and improve overall kidney health.

In addition to these direct effects on the kidneys, cistanche has been found to have beneficial effects on other organs and systems in the body. This holistic approach to health is particularly important in kidney disease, as the condition often affects multiple organs and systems. che has been shown to have protective effects on the liver, heart, and blood vessels, which are commonly affected by kidney disease. By promoting the health of these organs, cistanche helps improve overall kidney function and prevent further complications.

In conclusion, cistanche is a traditional Chinese herbal medicine used for centuries to treat kidney disease. Its active components have diuretic, antioxidant, anti-inflammatory, immunomodulatory, and regenerative effects, which help improve renal function and protect the kidneys from further damage. , cistanche has beneficial effects on other organs and systems, making it a holistic approach to treating kidney disease.