In this section : Renal
Kidney Biopsy Complications
Parenteral Iron for Non-HD CKD Patients
Management of uncomplicated Henoch-Schonlein Purpura (HSP) in under 16s
Prescribing Advice on Admission – Insulin
Sodium Glucose Transporter 2 Inhibitors (SGLT2i)
Gentamicin in Renal Replacement Therapy
Vancomycin in Renal Replacement Therapy
Haemodialysis Medication Prescribing
Contrast Associated AKI
Low Molecular Weight Heparin
Fluid Replacement in AKI
Management of Urinary Symptoms
Acute Kidney Injury (AKI)
Urinary Tract Infection
Urethral Catheterisation
Kidney Transplantation
Ureteric Colic & Renal Stones
Intravascular Catheter Related Blood Stream Infection
Care of Vascular Access
Urinary Incontinence
Peritoneal Dialysis Related Peritonitis
Intravascular Catheter Related Blood Stream Infection
Last updated 24th November 2022
Diagnosis
- More likely with temporary lines than tunnelled catheters, Femoral than Internal Jugular and Subclavian catheters.
- Suspect in any dialysis patient with line & temp 38º or more
- Haemodynamic instability, altered mental status, hypothermia and catheter dysfunction may be other less common manifestations of CRBSIs.
- Simultaneous blood culture should be obtained from the dialysis catheter or haemodialysis circuit blood line and peripheral vein. In the case of difficulty in obtaining peripheral samples take two blood cultures from the line or circuit at least 15 minutes apart.
- Remember also to check WCC, CRP and other sources of sepsis . Swab both catheter exit site and nose.
- 6CRBSI confirmed if culture from both samples grow the same organism & no other source of infection is found
- Around 75% are staphylococcal including staph aureus, MRSA and coag neg staph.
- Infections are either complicated (eg tunnel infection, endocarditis or osteitis) or uncomplicated (none of these).
Recommended Antibiotics for CRBSI
- Antibiotics that can be given post dialysis are preferred.
- Vancomycin is the first choice for empirical therapy of gram pos organisms in settings where MRSA prevalent
- Teicoplanin recommended if allergy to Vancomycin
- Single dose Gentamicin often given in view of rapid bactericidal effect but longer courses not advised unless Gentamicin is the only option.
- If necessary to provide continuing gram neg cover then ceftazidime is first choice, however Gentamicin may be a reasonable choice to be given after HD.
- Subsequent choice and dose of antibiotic should be altered in light of organism and sensitivities
- In all cases inform renal unit ASAP
Recommended Antibiotics for CRBSI
Vancomycin and Gentamicin as per protocol
Temporary Line Septicaemia
- If patient has a temporary line remove in head down position with catheter tip sent for culture, followed by pressure over exit site for 15 min and occlusive dressing
- Temporary line septicaemia should never be treated by leaving the catheter in situ or with antibiotic locks
- In all cases inform renal unit ASAP
Flowchart for Tunnelled Line Septicaemia
Links
- CRBSI Best Practice Guideline NDT Plus 2010;3:234-6
- Tunnelled Line Haemodialysis CRBSI Management and Prevention – UpToDate (June 2022)
Content updated by Dr Nadeeka Rathnamalala