Septicemia in long-term jugular hemodialysis catheters; eradicating infection by changing the catheter over a guidewire.

By convention, septicemia occurring from an infected vascular catheter is treated with antibiotics and removal of the catheter. This approach, used with surgically implanted long-term catheters would be expected to result in loss of the vascular access site. During a 57 month period, we treated 21 episodes of septicemia secondary to infection of long term indwelling double lumen jugular venous catheters in our hemodialysis unit. Seventeen of 21 episodes were managed successfully by changing the catheter over a guidewire, thus preserving the access site. No relapse was observed after the antibiotic therapy was stopped. Only four patients required complete removal of the catheter and subsequent use of another site.