Effectiveness of a new tunneled catheter in preventing catheter malfunction: a comparative study.
OBJECTIVE
To compare infection and malfunction rates of two different types of antimicrobial-eluting tunneled cuffed catheters (TCCs) for hemodialysis.


METHODS
The HemoSplit TCC with BioBloc (silver sulfadiazine) coating (n = 100, control group) and the Tal Palindrome Ruby TCC, which has a novel silver antimicrobial sleeve and a spiral-z tip design (n = 100, study group), were compared in this case-controlled study. The main endpoints were TCC infection and malfunction.


RESULTS
Primary-assisted TCC patency was significantly reduced with the BioBloc TCC (71% and 61% at 90 and 180 days, respectively) compared with the Palindrome Ruby TCC (94% at 90 and 180 days, P < .0001). Multivariate analysis identified only the BioBloc TCC and common femoral access site as independent predictors of worse patency. The unadjusted relative risk (95% confidence interval) for TCC dysfunction with the BioBloc compared with the Palindrome Ruby was 6.0 (2.33-15.53, P < .001), and the relative risk adjusted for access site was 3.2 (1.71-11.96, P = .002). The infection-free rates of the two TCC types were similar (P = .36). The reintervention-free rate for infection or malfunction was significantly better with the Palindrome Ruby TCC (76% and 58% at 90 and 180 days, respectively) than with the BioBloc TCC (60% and 45% at 90 and 180 days, respectively; P = .03).


CONCLUSIONS
The results support the use of the Palindrome Ruby TCC on the basis of the significantly lower thrombosis and reintervention rate; randomized trials are justified to confirm this finding and to evaluate its role in the prevention of TCC infection.
Kakkos
Stavros K
SK
Division of Vascular Surgery, Department of Surgery, Henry Ford Hospital, 2799 W Grand Boulevard, Detroit, MI 48202, USA.
Haddad
Georges K
GK
Haddad
Roger K
RK
Scully
Martha M
MM
D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control; D016022:Case-Control Studies; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling; D020099:Coated Materials, Biocompatible; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D012837:Silver Sulfadiazine / Q000008:administration & dosage*; D013927:Thrombosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D013997:Time Factors; D014654:Vascular Patency
D000890:Anti-Infective Agents; D020099:Coated Materials, Biocompatible; D012837:Silver Sulfadiazine