Effectiveness of a new tunneled catheter in preventing catheter malfunction: a comparative study.

Kakkos, Stavros K; Haddad, Georges K; Haddad, Roger K; Scully, Martha M

PURPOSE To compare infection and malfunction rates of two different types of antimicrobial-eluting tunneled cuffed catheters (TCCs) for hemodialysis. MATERIALS AND 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.