Tunneled hemodialysis catheters: use of a silver-coated catheter for prevention of infection--a randomized study.
OBJECTIVE
To determine whether silver-coated tunneled hemodialysis catheters reduce infection and to determine the frequency of central venous thrombosis and stenosis with percutaneous placement of right internal jugular vein dialysis catheters by interventional radiologists.


METHODS
Ninety-one patients were randomly assigned to a treatment (silver-coated catheter; n = 47) or control (identical catheter without silver coating; n = 44) arm. Baseline venography was performed. Catheter tips were cultured and venography was repeated at catheter removal.


RESULTS
Mean duration of catheter placement was 92 days. Infection occurred in 11 patients (five in the treatment group, six in the control group). Tip cultures in 15 patients (eight treatment, seven control) were positive without clinical infection. Infection and colonization rates were slightly but not significantly higher in the treatment group than in the control group. Silver-coated catheters in two (4%) patients were removed due to reaction to the coating. Completion venograms (n = 72) showed new minor abnormalities in four (6%) patients and major abnormalities (stenosis, thrombosis) in three (4%) patients. Permanent venous abnormalities occurred in two (3%) patients.


CONCLUSIONS
Silver coating does not confer a benefit against clinical infection or colonization. Interventional radiologic placement of tunneled dialysis catheters yields a low frequency of permanent central venous thrombosis and stenosis.
Trerotola
S O
SO
Department of Radiology, Indiana University School of Medicine, University Hospital, Indianapolis 46202-5253, USA.
Johnson
M S
MS
Shah
H
H
Kraus
M A
MA
McKusky
M A
MA
Ambrosius
W T
WT
Harris
V J
VJ
Snidow
J J
JJ
D001419:Bacteria / Q000254:growth & development; D001424:Bacterial Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000009:adverse effects; D015169:Colony Count, Microbial; D003251:Constriction, Pathologic / Q000209:etiology / Q000517:prevention & control; D004866:Equipment Contamination; D004867:Equipment Design; D005076:Exanthema / Q000139:chemically induced; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D017495:Hyperpigmentation / Q000139:chemically induced; D015994:Incidence; D007601:Jugular Veins / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D015641:Radiography, Interventional; D015642:Radiology, Interventional; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation*; D012834:Silver / Q000009:adverse effects; D013499:Surface Properties; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D018084:Ultrasonography, Interventional; D014652:Vascular Diseases / Q000209:etiology / Q000517:prevention & control
D012834:Silver