title: A prospective, randomized evaluation of the effect of silver impregnated subcutaneous cuffs for preventing tunneled chronic venous access catheter infections in cancer patients.
abstract: OBJECTIVE
  This study was performed to evaluate the effect of a silver-impregnated cuff on the incidence of catheter-related bacteremia/fungemia or tunnel tract infection in cancer patients with chronic dual-lumen tunneled venous access catheters.
  
  
  BACKGROUND
  Infection is a frequent and potentially life-threatening complication of tunneled chronic cuffed silastic central venous access catheters in cancer patients. Recent experience with antimicrobial silver-impregnated cuffs placed on nontunneled percutaneously inserted central venous catheters suggests that such a cuff may render the catheter less prone to infection.
  
  
  METHODS
  The authors prospectively randomized 200 cancer patients to receive either a dual-lumen 10 French tunneled cuffed silastic central venous access catheter or the same catheter with a second more proximal subcutaneous silver-impregnated cuff. All patients then were followed prospectively for infectious morbidity until the device was removed or the patient died.
  
  
  RESULTS
  The hazard rate for infection/day (95% confidence limits) was 0.0022 (0.0015 to 0.0030) for standard catheters compared with 0.0027 (0.0019 to 0.0037) for catheters with silver-impregnated cuffs (p = not significant). Regression analysis of infection-free interval of both catheter types shows no difference over the lifetime of catheter as well as the over the first 48 days after insertion.
  
  
  CONCLUSIONS
  The study indicated no effect of a silver-impregnated cuff in decreasing the incidence of catheter-related bacteremias/fungemias, tunnel infections, or the spectrum of causative microorganisms involved in cancer patients with tunneled chronic venous access catheters.
authors.affiliation: Department of Anesthesiology, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: J S
authors.initials: JS
authors.lastname: Groeger
authors.forename: A B
authors.initials: AB
authors.lastname: Lucas
authors.forename: D
authors.initials: D
authors.lastname: Coit
authors.forename: M
authors.initials: M
authors.lastname: LaQuaglia
authors.forename: A E
authors.initials: AE
authors.lastname: Brown
authors.forename: A
authors.initials: A
authors.lastname: Turnbull
authors.forename: P
authors.initials: P
authors.lastname: Exelby
mesh_terms: D000293:Adolescent; D000328:Adult; D016470:Bacteremia / Q000209:etiology / Q000517:prevention & control; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods*; D002908:Chronic Disease; D016469:Fungemia / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008875:Middle Aged; D009181:Mycoses / Q000209:etiology / Q000517:prevention & control*; D009369:Neoplasms / Q000628:therapy; D011446:Prospective Studies; D012834:Silver / Q000627:therapeutic use*
chemical_list: D012834:Silver