# Vascular access for hemodialysis and catheter-related bloodstream infections: a survey on preventive measures and treatment strategies by the EPDWG and ESPN Dialysis Working Group

## TL;DR

This survey of European pediatric hemodialysis centers shows inconsistent practices in managing catheter-related infections, highlighting the need for standardized protocols.

## Contribution

The study reveals variability in vascular access and infection management practices across European centers, linked to national HDI levels.

## Key findings

- Central venous catheters are the primary vascular access in 73.1% of surveyed centers.
- CRBSI rates and catheter replacements are higher in centers from countries with HDI < 0.90.
- Only 35.4% of centers use two cultures to diagnose CRBSI, and practices for catheter removal are inconsistent.

## Abstract

The choice of vascular access (VA) plays a key role in the success of hemodialysis (HD). Despite their widespread use, central venous catheters (CVCs) are associated with higher rates of dysfunction, thrombosis, and catheter-related bloodstream infections (CRBSI). We investigated current practices in pediatric HD across European pediatric nephrology centers, focusing on VA choices, infection control measures, and CRBSI management. An online questionnaire was e-mailed to 119 members of the European Society for Pediatric Nephrology (ESPN) Dialysis Working Group and European Pediatric Dialysis Working Group (EPDWG). Descriptive statistics were used to summarize practices across centers, comparative analyses between centers in countries with Human Development Index (HDI) > 0.90 and < 0.90. Thirty-one centers across Europe participated in the survey. CVCs were the primary VA in 73.1% of the centers. Twenty (66.7%) centers reported malfunction as the most common CVC complication, followed by catheter thrombosis (19.4%) and CRBSI (12.9%). The diagnostic approach for CRBSI varied widely, with 35.4% of centers relying on a single positive catheter culture, while 57.9% did not collect a second culture from the peripheral vein or HD circuit. The most common empirical treatment was glycopeptides combined with third-generation cephalosporins. Nearly all centers used intravenous antibiotics for less than 3 weeks, and over half modified lock solutions with antibiotics following CRBSI diagnosis. Catheter removal practices were inconsistent, even in cases of severe infection. Centers reported a total of 548 HD patients. Exit-site infections and CRBSI were observed in 98 (17.8%) and 155 (28.2%) patients, respectively. CRBSI rates and CRBSI-related catheter replacements were significantly higher in centers from countries with HDI < 0.90 and in centers without a dedicated pediatric HD unit.

Conclusion: The suboptimal adherence to current VA recommendations and wide variability in catheter care practices including the prevention, diagnosis, and management of CRBSI highlight the need for standardized pediatric-specific protocols to enhance catheter longevity and improve patient outcomes.
What is Known:• Central venous catheters are widely used in pediatric hemodialysis but carry a high risk of complications, especially catheter-related bloodstream infections (CRBSI).What is New:• This multinational survey reveals significant variability in vascular access selection, CRBSI prevention, diagnosis, and treatment across European pediatric hemodialysis centers, with clear disparities by national HDI levels.• The findings highlight the need for standardization of vascular access care and CRBSI management and evidence-based pediatric-specific guidelines.

What is Known:

• Central venous catheters are widely used in pediatric hemodialysis but carry a high risk of complications, especially catheter-related bloodstream infections (CRBSI).

What is New:

• This multinational survey reveals significant variability in vascular access selection, CRBSI prevention, diagnosis, and treatment across European pediatric hemodialysis centers, with clear disparities by national HDI levels.

• The findings highlight the need for standardization of vascular access care and CRBSI management and evidence-based pediatric-specific guidelines.

The online version contains supplementary material available at 10.1007/s00431-025-06703-7.