#EMconf: Dialysis Catheter Infections and Other Nephrology Pearls

This week our great nephrology team provided us pearls regarding catheter related bloodstream infections in addition to other valuable renal associated tips.

Catheter-Related Blood Stream Infections (CRBI):

  • Patients with catheter related bloodstream infections (CRBI) often present with fever, altered mental status and 'infection metastasis'
  • CRBI organisms more often Gram positive than Gram negative. Staph aureus, pseudomonas and fungi are the most common and dangerous organisms
  • Avoid removing catheter unless systemic symptoms or toxic appearing. Remember blood and catheter tip cultures!
  • Treatment for a CRBI is a 3 week antibiotic course from last negative blood culture.
  • Vancomycin (20mg/kg loading dose) with Cefepime (one gram on day one for dialysis patient) is reasonable starting regimen

Other Dialysis Pearls:

  • Volume overload in dialysis patients is a leading cause of mortality. Infections and cardiac disease also increase motality risk.
  • Ask if your dialysis patient still makes urine! It is mportant to maintain whatever residual renal function these patients have as they are already subject to severe fluid restriction. Having renal function allows patients to drink more water, have higher quality of life, and decreases risk of volume overload.
  • No data to support immediate dialysis of IV contrast to preserve residual renal function. Exception: Gadolinium for MRI needs to be dialyzed immediately over 3 sessions.