Table 7.

Unique features of catheter-related bloodstream infection among patients who are undergoing hemodialysis.

Usually outpatient status

The ability to provide parenteral antibiotics during hemodialysis sessions

Dialysis units are frequently at geographically remote sites and not adjacent to a hospital

A physician is not usually present

Blood samples for culture are usually sent to a remote laboratory with the potential for delayed incubation of blood culture bottles

Antibiotic drug levels are determined at a remote site and are not available promptly

Peripheral venous access is often unavailable or needs to be avoided

It is unclear if quantitative peripheral blood and catheter cultures differ if samples are obtained during a dialysis session

Catheter removal poses logistical issues, because it may require urgent placement of a new dialysis catheter

Peripherally inserted central venous catheter lines cause venous stenosis that precludes future access in the ipsilateral extremity

Preference is given to antibiotics that can be administered during hemodialysis treatments

Quantitative blood cultures and/or determining differential time to positivity are frequently unable to be done or determined

Limited drug formulary exists in outpatient dialysis units

Pharmacy support is unavailable in outpatient dialysis units