Infectious Complications From Vascular Access

Vascular access–associated infections are a preventable cause of morbidity, hospitalizations, and mortality in the hemodialysis population. Central venous catheters (CVCs) disproportionately contribute to vascular access infections when compared to arteriovenous fistulas (AVFs) and grafts (AVGs). Although there has been a significant decline in CVC use in prevalent patients over the past decade, largely due to the success of the “Fistula First/Catheter Last” initiative, CVCs remain the most common vascular access used at the time of hemodialysis initiation. Reducing CVC use in hemodialysis is the cornerstone of the strategy to improve safety outcomes for patients. In addition to CVC reduction, implementation of meticulous antiseptic techniques during CVC connection/disconnection and strict attention to CVC care by patients when not in use are important tools for reducing infections. The core interventions for hemodialysis CVC care identified by the Centers for Disease Control and Prevention (CDC) have been proven to be effective in reducing CVC-related bloodstream infections (BSIs) and hospitalizations for sepsis. Newly developed tools addressing CVC antisepsis have become available and include antiseptic-impregnated exit-site dressings, hub devices, and antimicrobial CVC locks. This chapter provides an overview of the clinical outcomes associated with hemodialysis CVCs compared with AVGs and AVFs and reviews strategies for prevention and management of CVC, AVG, and AVF infections.