Paper Title
Evaluation of Outcome and Survival of Patients with Temporary Hemodialysis Catheters

Abstract
Background- Vascular Access is the most important factor in successful management of chronic hemodialysis patients. Dialysis vascular access is at the same time a "lifeline" and the "Achilles heel" of hemodialysis.Temporary hemodialysis catheters have made it possible to deliver hemodialysis to patients without a functional vascular access.There is paucity of data regarding the outcome and survival of patients with temporary hemodialysis catheters in India and hence this study to evaluate and understand the various indications, outcomes and complications of temporary hemodialysis catheters. Methods- Prospective data on all Temporary hemodialysis catheters inserted in patients after applying the inclusion and exclusion criteria admitted to medicine wards and ICU of Bharati medical college and hospital Pune, India over a period of 2 years extending from June 2018 to June 2020 was collected. Results- In our study the following observations were made.Total 250 patients above the age of 18 years, in whom a temporary HD catheter was inserted, were included. The mean age of the patients was 50.90 ± 11.09 years, out of which 59.2% (148) were belonged to age group between 40-60 years, while 15.6% (39) and 25.2% (63) were having age <40 and >60 years respectively, Out of total 250 patients with Temporary Hemodialysis catheters, 167 (66.8%) were males and 83 (33.2%) were females. When the percentages of both genders compared, the number of males was higher significantly (<0.0001) than the number of females. The co-morbidities present in patients with Temporary Hemodialysis catheters, were diabetes mellitus (142 (56.8%)), hypertension (117 (46.8%)), IHD (55 (22%)), CVA (36 (14.4%) and others (Hypothyroidism, bronchial asthma, COPD, TB) which were present in 17 (6.8%) patients. There were 2 main indications noted for insertion of catheters among the study subjects, including 86 (34.4%) patients due to current vascular related problems( failure of permanent catheter , failed AV fistula ) and in 164 subjects (65.6%) inserted as a need for hemodialysis as they did not have a vascular access. The sites of insertion of catheter in study subjects were right internal jugular vein in 222 (88.8%), femoral vein in 15 (6%) and left internal jugular vein in 13 (5.2) patients. The complications recorded among the patients with temporary hemodialysis catheters were, procedural complications (2 (0.8%)), CRBSI (85 (34%)), block/decreased flow (30 (12%)), infective endocarditis (2 (0.8%)) and SVC syndrome (4 (1.6%)). Along with the catheter tip culture the blood culture was also carried out which showed the most prevalent organism to be Staphylococcus aureus (MRSA) (38 (15.2%)), followed by pseudomonas (16 (6.4%)), acinetobacter (14 (5.6%)), Klebsiella pneumoniae (8 (3.2%)) and candida (6 (2.4%)). The catheter tip swab was sent for culture and sensitivity, among the study group the most prevalent organism present was Staphylococcus aureus (MRSA) (38 (15.2%)), followed by pseudomonas (16 (6.4%)), acinetobacter (14 (5.6%)), Klebsiella pneumonia (8 (3.2%)), candida (6 (2.4%)) and Stenotrophomonas maltophilia(2 (0.8%)).Among all the study subjects included in the present study the temporary hemodialysis catheter was removed in 170 (68%) patients, while it was retained in 80 (32%) patients.Out of the total 170 patients in whom the catheter was removed, indications for removal were elective in 45 (26.47%), infection in 85 (50%), thrombosis in 30 (17.65%) patients and 10 patients had other causes of removal of catheter. Conclusion-Vascular access for HD in patient with CKD was the most common indication for insertion of Temporary HD cathetrs in our study. The most common complication in our study group with temporary hemodialysis catheters was Catheter related blood stream infection followed by mechanical complications. The most prevalent organism associated with CRBSI was found to be Staphylococcus aureus (MRSA). Keywords- CKD, HD, Temporary Hemodilaysis Catheters