A 2016 article in the International Journal of Nephrology and Renovascular Disease evaluates management strategies for preventing catheter-related bloodstream infections, with recognition that many patients begin hemodialysis (HD) with a catheter. The authors conclude that “Early efforts must be directed toward preventative care emphasizing placement of other vascular accesses or initiating an alternative dialysis modality, such as timely peritoneal dialysis (PD) to avert HD catheter placement before it becomes necessary.”

Findings include:

• “Urgent start PD” programs are a safe alternative to HD in patients without an established AV fistula or graft.
• Should no options exist outside of catheter placement, proper catheter care and infection control procedures implemented through educating and auditing dialysis unit staff as well as patients, are the first step in preventing infections.
• In high-risk groups for whom all other conservative measures to prevent infection have failed, the authors recommend consideration of antimicrobial lock (AML) therapy.

“Prevention of catheter-related bloodstream infections in patients on hemodialysis: challenges and management strategies,”Int J Nephrol Renovasc Dis. 2016; 9: 95-103. Published online 2016 Apr 18. doi: 10.2147/IJNRD.S76826