Comparable rates of catheter-related bloodstream infections between non-tunneled and tunneled hemodialysis catheters

Background: A hemodialysis catheter may serve as a short- or medium-term vascular access solution. Current guidelines suggest restricting non-tunneled catheter use to 2 weeks, partially based on studies using straight non-tunneled jugular catheters, which have now been widely replaced with pre-curved catheters. We compared the rate of catheter-related blood stream infections (CRBSIs) and possible CRBSIs (PCRBSIs) of pre-curved non-tunneled and tunneled catheters in our hemodialysis center. Methods: This was a retrospective study including patients dialyzed on an outpatient basis between 1 January 2018 and 1 July 2024, with a follow-up until 1 March 2025. The primary aim was to compare the rates of CRBSIs. Results: In 301 patients, 625 non-tunneled single lumen catheter pairs and 53 double lumen tunneled catheters were used. There were 53 CRBSIs in non-tunneled and 10 in tunneled catheters, with identical incidence rate (0.48/1000 catheter-days in both groups). Analyzing CRBSIs and PCRBSIs together also showed similar infection rates [0.66 vs 0.58, incidence rate ratio (IRR) with 95% confidence interval 1.14 (0.6–2.1), P = .68]. Two subanalyses were made: CRBSI IRR in 27 patients with both types of catheters during study period was 1.37 (0.55–3.41, P = .49) and 2.01 (0.52–7.72, P = .47) in 36 patients after their first CRBSI. Time to CRBSI was also comparable in all analyses. Conclusions: Our study found no significant difference in the incidence of CRBSIs. We conclude that prolonged use of non-tunneled pre-curved catheters, which are easily managed, is a viable option for patients awaiting construction of arteriovenous fistula, insertion of a peritoneal catheter or kidney transplantation in a reasonable time. Promising results on long-term use from this study need to be confirmed in prospective studies.