Technique preserves venous access, manages infections.


SEATTLE—Over-the-wire exchange (OTWE) and catheter removal and replacement (RR) are similarly effective for managing fungal infections associated with tunneled dialysis catheters, according to a new study. OTWE resulted in similar fungal re-infection rates while allowing for preservation of dialysis access sites.

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“This was a retrospective study, and it is a small series,” said senior investigator Scott Trerotola, MD, chief of interventional radiology at the Hospital of the University of Pennsylvania in Philadelphia.


“However, what we found was that if a patient has limited venous reserve, we should probably do an over-the-wire exchange. If, on the other hand, the patient has lots of access sites and we are not going to lose the access site by removing the catheter, then we should probably still do removal and replacement at least until we have amassed a larger experience with over-the-wire exchange for fungal infection.”


Study findings were presented here at the Society of Interventional Radiology annual meeting.


OTWE is standard procedure for tunneled dialysis catheter-associated bacteremia, but fungemia is still considered a contraindication to this procedure, Dr. Trerotola said.


The study, led by Noah Kornfield, a second-year medical student, iden-tified 413 infections associated with tunneled dialysis catheters, of which 24 were fungal. The 24 events occurred in 20 different patients, who had a mean age of 60 years (range, 40-86 years).


The management of these 24 fungal infections involved RR of 13 catheters and an OTWE for the remaining 11. The primary end points for this study were time to next catheter replacement, end of need for catheter, or time of loss to follow-up.


Of the 13 RR catheters, five were removed because of re-infection. The remaining eight catheters were lost to follow-up. Of the 11 catheters with OTWE, six were removed because of reinfection (three fungal, one combined fungal and bacterial, and two bacteremias with no tip culture). The remaining five were removed because of malfunction, mature access, and loss to follow-up.