Abstract:
Background: Catheter-related bloodstream infections (CRBSIs) are the main complications associated with the use of permanent central venous catheters (CVCs). However, standardized management protocols for infected tunneled CVCs remain heterogeneous. We present an innovative stylet-protected guidewire-exchange technique designed to minimize contamination and preserve vascular access sites.
Methods: We performed a retrospective, observational, single-center study of infected tunneled CVC replacement at the Nephrology Unit of Policlinico A. Gemelli Foundation (Rome) from January 2019 to June 2024. Follow-up ranged from 1 to 4 years. The primary endpoint was infection-free survival, defined as time to relapse (recurrent CRBSI with the same pathogen) or reinfection (a different pathogen).
Results: A total of 99 CVC exchanges were performed in 99 patients (M 50.5%, F 49.5%; median age: 72 years, IQR 62-78.5). To assess the safety of the technique, guidewire cultures were obtained, confirming persistence of the initial CRBSI pathogen. Despite positive guidewire cultures, relapse by the same pathogen occurred in only 2% of cases: one Pseudomonas aeruginosa (at 3 months) and one Staphylococcus aureus (at 8 months). Reinfection with different pathogens occurred in 11.1% of cases (11 patients) after a median of 283 days (IQR 121-642). All catheters maintained extracorporeal blood flow ⩾250 mL/min, ensuring adequate dialysis.
Conclusions: This stylet-protected guidewire-exchange demonstrated excellent infection-free survival, including infections caused by high-risk pathogens such as Staphylococcus aureus. These results support guidewire exchange as a safe, effective and reproducible method for replacing infected tunneled CVCs in hemodialysis patients.
Reference:Lomeo E, D’Ascenzo FM, Sturniolo A, Mangiacapra R, Aureli F, Pesce F, Grandaliano G. Stylet-protected guidewire-exchange for infected tunneled hemodialysis catheters: Outcomes from a single-center retrospective study. J Vasc Access. 2026 Jul 7:11297298261452710. doi: 10.1177/11297298261452710. Epub ahead of print. PMID: 42415361.