[Blood cultures in hemodialysis: how an ad hoc protocol can make the difference]

In hemodialysis (HD), the vascular access of choice is the arteriovenous fistula (AVF), but the aging of the dialysis population and comorbidities make the central venous catheter (CVC) increasingly unavoidable as the first choice, despite the high incidence of infectious complications such as catheter-related bloodstream infection (CRBSI). In the dialysis centers of the vast Pordenone area, up to December 31, 2022, patients with CVC represented 42% of the total. Suspected septic episodes during dialysis require blood cultures from both the CVC lumens and a peripheral vein. It was necessary to develop a clinical protocol focused on the uremic patient, with the aim of obtaining reliable culture results and reducing false positives and the consequent risk of CVC loss. After a literature search and consultation among different professionals, a blood-culture protocol was developed with indications and procedures in which peripheral-vein sampling was replaced by sampling from the extracorporeal circuit. The protocol was introduced with daily audits and supervised during its application. From January 2020 onwards, all blood cultures and detailed results were recorded in a computerized file and evaluated according to the differential time to positivity (DTTP). As of December 31, 2022, no sample was false positive and only seven cases were attributable to CRBSI, corresponding to 0.095 per 1,000 CVC days. In HD, the CVC must be recognized as a separate entity. The design of an ad hoc protocol made it possible to obtain reliable blood-culture results, simplify procedures, preserve vascular access and avoid unnecessary CVC removal.