Clinical outcomes associated with the use of the NexSite hemodialysis catheter with new exit barrier technology: Results from a prospective, observational multi-center registry study

Autoři: Jeffrey G. Hoggard aff001;  Richard D. Blair aff002;  Manuel Montero aff002;  Moustafa A. Moustafa aff003;  Joseph Newman aff004;  Pablo E. Pergola aff005;  Nathan Saucier aff002;  Clarence J. Wheeler, III aff006;  Leonard A. Mermel aff007;  John R. Ross aff008;  Anatole D. Beserab aff009
Působiště autorů: Capital Nephrology Associates, Raleigh, North Carolina, United States of America aff001;  Eastern Nephrology, New Bern, North Carolina, United States of America aff002;  South Carolina Nephrology and Hypertension Center, Orangeburg, South Carolina, United States of America aff003;  Eastern Nephrology, Greenville, North Carolina, United States of America aff004;  Renal Associates PA, San Antonio, Texas, United States of America aff005;  Kidney and Blood Pressure Clinic of Lubbock, Lubbock, Texas, United States of America aff006;  Division of Infectious Diseases, Rhode Island Hospital and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America aff007;  Access Connections LLC, Orangeburg, South Carolina, United States of America aff008;  Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, United States of America aff009
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article



Decreasing the risk of catheter related bloodstream infections (CRBSIs) remains a key focus for improving outcomes and reducing cost of care for hemodialysis (HD) patients. Recent studies demonstrate CRBSI rates can be improved by managing bacterial colonization at the catheter exit site. Herein we present the results of a study documenting the clinical performance of the NexSite HD catheter, a new tunneled central venous catheter which incorporates Exit Site Management (ESM) technology.


We conducted an observational study using a prospective, multi-center registry of HD patients implanted with the NexSite HD catheter. The primary endpoint for the study was CRBSI rate for a period up to 180-days following catheter placement. Secondary endpoints included device placement success rate, exit site healing, development of an exit site or tunnel infection, and early or late non-infectious catheter-related complications. All reasons for early non-elective catheter removal were recorded.


A total of 115 HD patients at 6 sites were included in the final analysis. Cumulative catheter use was 10,924 days with a mean duration of 95 days. Seven patients experienced CRBSIs during the study period resulting in a CRBSI rate of 0.64 per 1,000 catheter-days. Seventy-four patients (64.3%) had either elective catheter removal (n = 56) or utilized the catheter for the entire 180-day observation period (n = 18). Thirty-five patients (30%) underwent non-elective device removal either due to CRBSI (n = 5), low flow (n = 16), exit site issues (n = 7), or for other causes (n = 7). Six patients died during the observation period with 1 death due to CRBSI-associated complications and the remaining 5 deaths attributed to non-device related causes.


Our findings demonstrate that the NexSite HD catheter equipped with ESM technology can achieve a CRBSI rate in compliance with the NKF KDOQI (National Kidney Foundation Kidney Disease Outcome Quality Initiatives) Clinical Performance Guidelines stated goal of less than 1.0/1,000 catheter-days when used in hemodialysis patients using current standard of care nursing protocols.

Klíčová slova:

Blood – Bloodstream infections – Catheters – Fistulas – Medical devices and equipment – Medical dialysis – Medical implants – Jugular vein


1. Lynch JR, Wasse H, Armistead NC, McClellan WM. Achieving the goal of the Fistula First Breakthrough Initiative for prevalent maintenance hemodialysis patients. Am J Kidney Dis. 2011;57(1):78–89. doi: 10.1053/j.ajkd.2010.08.028 21122960

2. Arhuidese IJ, Orandi BJ, Nejim B, Malas M. Utilization, patency, and complications associated with vascular access for hemodialysis in the United States. J Vasc Surg. 2018;68(4):1166–1174. doi: 10.1016/j.jvs.2018.01.049 30244924

3. United States Renal Data System. 2017 USRDS annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2017.

4. Ravani P, Palmer SC, Oliver MJ, Quinn RR, MacRae JM, Tai DJ, et al. Associations between hemodialysis access type and clinical outcomes: a systematic review. J Am Soc Nephrol. 2013;24(3):465–473. doi: 10.1681/ASN.2012070643 23431075

5. Miller LM, Clark E, Dipchand C, Hiremath S, Kappel J, Kiaii M, et al, on behalf of the Canadian Society of Nephrology Vascular Access Work Group Hemodialysis Tunneled Catheter-Related Infections. Can J Kidney Health Dis. 2016; 3: 2054358116669129. Published online 2016 Sep 27.

6. Engemann JJ, Friedman JY, Reed SD, Griffiths RI, Szczech LA, Kaye KS, et al. Clinical outcomes and costs due to Staphylococcus aureus bacteremia among patients receiving long-term hemodialysis. Infect Control Hosp Epidemiol. 2005;26:534–539, doi: 10.1086/502580 16018428

7. Ramanathan V, Chiu EJ, Thomas JT, Khan A, Dolson GM, Darouiche RO. Healthcare costs associated with hemodialysis catheter related infections: a single-center experience. Infect Control Hosp. Epidemiol 2007;28:606–609. doi: 10.1086/513617 17464925

8. Reed SD, Friedman JY, Engemann JJ, Griffiths RI, Anstrom KJ, Kaye KS, et al. Costs and outcomes among hemodialysis-dependent patients with methicillin-resistant or methicillin-susceptible Staphylococcus aureus bacteremia. Infect Control Hosp Epidemiol. 2005; 26:175–183. doi: 10.1086/502523 15756889

9. Nissenson AR, Dylan ML, Griffiths RI, Yu HT, Dean BB, Danese MD, et al. Clinical and economic outcomes of Staphylococcus aureus septicemia in ESRD patients receiving hemodialysis. Am J Kidney Dis 2005;46:301–308. doi: 10.1053/j.ajkd.2005.04.019 16112049

10. McCann M, Moore ZEH. Interventions for preventing infectious complications in haemodialysis patients with central venous catheters. Cochrane Database Syst Rev 2010; (1):CD006894Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006;48 Suppl 1:S176-247. doi: 10.1002/14651858.CD006894.pub2 20091610

11. Cheesbrough JS, Finch RG, Burden RP. A prospective study of the mechanisms of infection associated with hemodialysis catheters. J Infect Dis 1986;154(4):579–589. doi: 10.1093/infdis/154.4.579 3745972

12. Lok CE, Mokrzycki MH. Prevention and management of catheter-related infection in hemodialysis patients. Kidney Int. 2011;79(6),587–598. doi: 10.1038/ki.2010.471 21178979

13. Lok CE, Stanley KE, Hux JE, Richardson R, Tobe SW, Conly J. Hemodialysis infection prevention with polysporin ointment. J Am Soc Nephrol. 2003;14(1):169–79. doi: 10.1097/01.asn.0000038688.76195.a4 12506149

14. Battistella M, Bhola C, Lok CE. Long-term follow-up of the Hemodialysis Infection Prevention with Polysporin Ointment (HIPPO) Study: a quality improvement report.Am J Kidney Dis. 2011;57(3):432–41. doi: 10.1053/j.ajkd.2010.10.009 21216512

15. Farber A, Imrey PB, Huber TS, Kaufman JM, Kraiss LW, Larive B, et al; HFM Study Group. Multiple preoperative and intraoperative factors predict early fistula thrombosis in the Hemodialysis Fistula Maturation Study. J Vasc Surg. 2016;63(1):163–170. doi: 10.1016/j.jvs.2015.07.086 26718822

16. Allon M, Imrey PB, Cheung AK, Radeva M, Alpers CE, Beck GJ, et al; Hemodialysis Fistula Maturation (HFM) Study Group. Relationships between clinical processes and arteriovenous fistula cannulation and maturation: A multicenter prospective cohort study. Am J Kidney Dis. 2018;71(5):677–689. doi: 10.1053/j.ajkd.2017.10.027 29398178

17. Astor BC, Eustace JA, Powe NR, Klag MJ, Fink NE, Coresh J. CHOICE Study. Type of vascular access and survival among incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Study. J Am Soc Nephrol. 2005;16(5):1449–1455. doi: 10.1681/ASN.2004090748 15788468

18. Knuttinen MG, Bobra S, Hardman J, Gaba RC, Bui JT, Owens CA. A review of evolving dialysis catheter technologies. Semin Intervent Radiol. 2009;26(2):106–114. doi: 10.1055/s-0029-1222453 21326500

19. Lai NM, Chaiyakunapruk N, Lai NA, O'Riordan E, Pau WS, Saint S. Catheter impregnation, coating or bonding for reducing central venous catheter-related infections in adults. Cochrane Database Syst Rev. 2016 Mar 16;3:CD007878. doi: 10.1002/14651858.CD007878.pub3 26982376

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2019 Číslo 10
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