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Prophylactic antibioitic use during dialysis catheter exchange
S42
’
Monday
Scientific Session
’
JVIR
Does the Time Span between Access Thrombosis and Intervention Affect the Outcome of Dialysis Access Declot Procedures? Retrospective Analysis of a Single Center Experience Type
MONDAY: Scientific Sessions
Graft Graft Graft Graft Fistula Fistula Fistula Fistula
Group (n) 0 day (46) 1 day (52) 2 days (13) 4 2 days (11) 0 day (9) 1 day (18) 2 days (7) 42 days (4)
Percent clinical success (p-value) 89 85 (0.56) 92 (1.00) 64 (0.06) 89 78 (0.64) 86 (1.00) 50 (0.20)
Purpose: To determine how the success of fistula and graft declot procedures depends on the time span between access thrombosis and intervention. Materials and Methods: A retrospective analysis was conducted of all declot procedures at our institution over a 30 month period (January 2008 through June 2010). Medical records were queried for type and location of access, date of access thrombosis, date of intervention, outcome of intervention, and date of subsequent intervention. The endpoints were clinical success and primary patency as defined by K/DOQI. Data were grouped by the type of access (graft and fistula) and the number of days between thrombosis and intervention (0 day, 1 day, 2 days and 4 2 days). The endpoints for each 0 day group were compared to respective 1 day, 2 day and 4 2 day groups using the Fisher Exact Test. Results: 160 declot procedures were included (122 grafts and 38 fistulas). These involved 88 patients and 100 different accesses (72 grafts and 28 fistulas). For grafts, percent clinical success, primary patency at 90 days and at 1 year were 85%, 45% and 14%, respectively. For fistulas, percent clinical success, primary patency at 90 days and at 1 year were 79%, 61% and 26%, respectively. Comparison of 0 day groups with respective 1 day, 2 day and 4 2 day groups are below. Conclusion: For both grafts and fistulas, there was a trend toward lower clinical success if intervention was performed at 4 2 days after thrombosis, but not at a 1 or 2 day time span. For both grafts and fistulas, primary patency did not depend on the time span between access thrombosis and intervention.
9:12 AM
Abstract No. 79
Prophylactic antibioitic use during dialysis catheter exchange E. Barzel1, E. Lacson, Jr.2, L.R. Petrusky3, L. Ma2, G. Miller4, F.W. Maddux2, G.S. Pressman5; 1American Access Care of NJ, Fresenius Vascular Care, Cherry Hill,
Percent 90 day primary patency (p-value) 43 46 (0.84) 46 (1.00) 45 (1.00) 67 61 (1.00) 57 (1.00) 50 (1.00)
Percent 1 year primary patency (p-value) 9 19 (0.16) 15 (0.61) 9 (1.00) 33 22 (0.65) 14 (0.59) 50 (1.00)
NJ; 2Clinical Science, Epidemiology, and Research, Fresenius Medical Care, North America, Waltham,, MA; 3 Quality Improvement, Fresenius Vascular Care, Glen Rock, PA; 4American Access Care of Brooklyn, Fresenius Vascular Care, New York, NY; 5Cardiology, Albert Einstein Medical Center, Philadelphia, PA Purpose: To determine if prophylactic antibiotic use lowers the incidence of infection in the first week following tunneled dialysis catheter exchange. Materials and Methods: Our 28 ambulatory surgery centers performed dialysis catheter exchanges for poorly functiong catheters. Some physicians give prophylactic antibiotics and some do not. Initiated as part of our QA program, and an MOC project, we evaulated each patient’s outcome one week after their procedure. Data recorded when the procedures were performed included presence of preexisting infection, use of antibiotic, antibiotic type, route of administration, and timing of administration. Follow-up phone calls scheduled 6-8 days after intervention, were made to each patient’s dialysis center to determine the presence of the following complications: infection, bleeding, nausea/vomiting, respiratory difficulty, and pain. This information was enteried into a central database. The QA/MOC team assessed the data. A WIRB exemption was obtained for publication of a retrospective analysis of the database from 1/1/2010 through 12/ 31/2011. All patient identifiers were removed and the database was submitted for statistical analysis. Only patients without preexisting infection were included in the analysis. Results: There was a significant decrease in the rate of infection in patients who received IV antibiotics, primarily cefazolin 1gm, given pre-procedure or intraprocedure just prior to the intervention. Oral antibiotics given peri-procedure did not decrease infection rates. There was no significant difference in other rates of complications between those who did and did not receive antibiotics. Conclusion: Intravenous cefazolin given prophylactically just prior to tunneled dialysis catheter exchange significantly reduces the rate of infection at one week.
Prophylactic Antibioitic Use during Dialysis Catheter Exchange
Total Incomplete data No antibiotics Cefazolin Any IV antibiotic Any oral antibiotic
Number of Procedures 3345 140 1216 1356 1416 573
Number of Infections
Rate of Infection
14 1 1 5
1.15% 0.07% 0.07% 0.87%
P-value
95% Confidence Interval
Odds Ratio
0.0003 0.0002 0.5915
2.07-120.19 2.16-125.51 0.47-3.69
15.78 16.48 1.32
’
Monday
Scientific Session
’
JVIR
Does the Time Span between Access Thrombosis and Intervention Affect the Outcome of Dialysis Access Declot Procedures? Retrospective Analysis of a Single Center Experience Type
MONDAY: Scientific Sessions
Graft Graft Graft Graft Fistula Fistula Fistula Fistula
Group (n) 0 day (46) 1 day (52) 2 days (13) 4 2 days (11) 0 day (9) 1 day (18) 2 days (7) 42 days (4)
Percent clinical success (p-value) 89 85 (0.56) 92 (1.00) 64 (0.06) 89 78 (0.64) 86 (1.00) 50 (0.20)
Purpose: To determine how the success of fistula and graft declot procedures depends on the time span between access thrombosis and intervention. Materials and Methods: A retrospective analysis was conducted of all declot procedures at our institution over a 30 month period (January 2008 through June 2010). Medical records were queried for type and location of access, date of access thrombosis, date of intervention, outcome of intervention, and date of subsequent intervention. The endpoints were clinical success and primary patency as defined by K/DOQI. Data were grouped by the type of access (graft and fistula) and the number of days between thrombosis and intervention (0 day, 1 day, 2 days and 4 2 days). The endpoints for each 0 day group were compared to respective 1 day, 2 day and 4 2 day groups using the Fisher Exact Test. Results: 160 declot procedures were included (122 grafts and 38 fistulas). These involved 88 patients and 100 different accesses (72 grafts and 28 fistulas). For grafts, percent clinical success, primary patency at 90 days and at 1 year were 85%, 45% and 14%, respectively. For fistulas, percent clinical success, primary patency at 90 days and at 1 year were 79%, 61% and 26%, respectively. Comparison of 0 day groups with respective 1 day, 2 day and 4 2 day groups are below. Conclusion: For both grafts and fistulas, there was a trend toward lower clinical success if intervention was performed at 4 2 days after thrombosis, but not at a 1 or 2 day time span. For both grafts and fistulas, primary patency did not depend on the time span between access thrombosis and intervention.
9:12 AM
Abstract No. 79
Prophylactic antibioitic use during dialysis catheter exchange E. Barzel1, E. Lacson, Jr.2, L.R. Petrusky3, L. Ma2, G. Miller4, F.W. Maddux2, G.S. Pressman5; 1American Access Care of NJ, Fresenius Vascular Care, Cherry Hill,
Percent 90 day primary patency (p-value) 43 46 (0.84) 46 (1.00) 45 (1.00) 67 61 (1.00) 57 (1.00) 50 (1.00)
Percent 1 year primary patency (p-value) 9 19 (0.16) 15 (0.61) 9 (1.00) 33 22 (0.65) 14 (0.59) 50 (1.00)
NJ; 2Clinical Science, Epidemiology, and Research, Fresenius Medical Care, North America, Waltham,, MA; 3 Quality Improvement, Fresenius Vascular Care, Glen Rock, PA; 4American Access Care of Brooklyn, Fresenius Vascular Care, New York, NY; 5Cardiology, Albert Einstein Medical Center, Philadelphia, PA Purpose: To determine if prophylactic antibiotic use lowers the incidence of infection in the first week following tunneled dialysis catheter exchange. Materials and Methods: Our 28 ambulatory surgery centers performed dialysis catheter exchanges for poorly functiong catheters. Some physicians give prophylactic antibiotics and some do not. Initiated as part of our QA program, and an MOC project, we evaulated each patient’s outcome one week after their procedure. Data recorded when the procedures were performed included presence of preexisting infection, use of antibiotic, antibiotic type, route of administration, and timing of administration. Follow-up phone calls scheduled 6-8 days after intervention, were made to each patient’s dialysis center to determine the presence of the following complications: infection, bleeding, nausea/vomiting, respiratory difficulty, and pain. This information was enteried into a central database. The QA/MOC team assessed the data. A WIRB exemption was obtained for publication of a retrospective analysis of the database from 1/1/2010 through 12/ 31/2011. All patient identifiers were removed and the database was submitted for statistical analysis. Only patients without preexisting infection were included in the analysis. Results: There was a significant decrease in the rate of infection in patients who received IV antibiotics, primarily cefazolin 1gm, given pre-procedure or intraprocedure just prior to the intervention. Oral antibiotics given peri-procedure did not decrease infection rates. There was no significant difference in other rates of complications between those who did and did not receive antibiotics. Conclusion: Intravenous cefazolin given prophylactically just prior to tunneled dialysis catheter exchange significantly reduces the rate of infection at one week.
Prophylactic Antibioitic Use during Dialysis Catheter Exchange
Total Incomplete data No antibiotics Cefazolin Any IV antibiotic Any oral antibiotic
Number of Procedures 3345 140 1216 1356 1416 573
Number of Infections
Rate of Infection
14 1 1 5
1.15% 0.07% 0.07% 0.87%
P-value
95% Confidence Interval
Odds Ratio
0.0003 0.0002 0.5915
2.07-120.19 2.16-125.51 0.47-3.69
15.78 16.48 1.32