Non-Infectious Complications of Non-Tunneled Central Venous Catheterization for Hemodialysis: Incidence and Reasons in Ouagadougou (Burkina Faso)

Goal: Evaluate the importance and reasons of non-infectious complications of non-tunneled central venous catheterization in our hemodialysis unit. Patients and methods: The study, a prospective type, was conducted in the department of nephrology and hemodialysis of Yalgado Ouedraogo University Hospital Center (YO-UHC) in Ouagadougou, Burkina Faso, from 15 February to 30 June 2015. Patients in whom a new central venous catheter (CVC) was inserted during the study period were included. Catheterization-related complications were noted. Results: During the study period, 156 CVCs (9 per week) were placed in femoral (56.4%), internal jugular (40.4%) or subclavian vein (3.2%). There were 114 patients (59.7% of men and 40.3% of women), average age 41.8 ± 17.1 years, low socio-economic level in 64% of cases. At least a non-infectious complication was observed in 67 cases representing 42.9%. They were: puncture failure (40%), arterial puncture (12.2%), puncture of the thoracic duct (1.3%), pneumothorax (1.3%), bleeding related to the catheter insertion (5.8%), hematoma (1.3%), opposite direction (0.6%), dysfunction of the CVC (10.3%), femoralthrombophlebitis (3.2%). Conclusion: Non-infectious complications of non-tunneled central venous catheterization in our hemodialysis unit were frequent and sometimes severe. Their common denominator was the absence of ultrasound guidance. Our study reaffirms the need for equipping with Doppler ultrasound in our hemodialysis units, even in developing countries, for better security of the patient during central venous catheterization.

Factors Associated with Infection of the Central Venous Catheter for Hemodialysis in Ouagadougou (Burkina Faso)

Goal: The goal is to evaluate infections associated with central venous catheters of hemodialysis (CRI) in hemodialysis patients in Ouagadougou. Patients and methods: The study was cross-sectional, from February 15th to June 30th, 2015. It was conducted in Ouagadougou (Burkina Faso). We included patients with a new central venous catheter (CVC) inserted in the hemodialysis unit. The timeout for making an arteriovenous fistula (AVF) for chronic hemodialysis in Ouagadougou may exceed six months. The CVCs used at the time of the study were made of polyurethane and non-tunneled. Sociodemographic, clinical and paraclinical data were collected and analyzed. Results: During the study period, 156 CVCs were installed in 114 patients, and the average age was 41.8 ± 17.1 years. A CRI occurred on 39 CVCs for a rate of 9.5/1000 days-catheter. The frequency of CRI was 28.4%, 20.6% and 20% respectively in femoral, jugular, and subclavian veins. The culture of the tip of the catheter was done in 21 cases. Fifteen germs have been identified: eight cases of Gram-positive cocci (53.3%) and seven cases of Gram-negative bacilli (46.7%). It was essentially staphylococci (eight cases). In univariate analysis, a period of use of the CVC in chronic hemodialysis over 10 days was significantly (p = 0.01;r = 2.91) associated with the catheter-related infection (CRI). Conclusion: The impact of the CRI was very high in our series. The associated factor in the univariate analysis was the long period of use of the CVC. The most diligent production of AVFs at the YO-UHC would contribute to a significant reduction of the CRI.