Large Bore Catheters with Surface Treatments versus Untreated Catheters for Blood Access

Abstract

Infection, thrombosis, and stenosis are among the most frequent complications associated with blood contacting catheters. Because these problems are usually related to surface properties of the base catheter material, surface treatment processes, such as ion implantation and ion beam assisted deposition (IBAD) (silver based coatings), can be used to mitigate such complications. Because these ion beam based processes affect only the near-surface region (approximately the outer 1 microm), there is little effect on bulk material properties. This study evaluated silver coated and implanted large bore catheters used for extracorporeal detoxification. In a 186 patient prospective study, 225 large bore catheters were inserted into the internal jugular or subclavian veins. 85 surface treated catheters (Spi-Argent, Spire Corporation, Bedford, MA-USA; n=39 acute catheters, n= 46 long-term catheters) and 28 catheters with surface treatment (Spi-Silicone, Spire Corporation, Bedford, MA-USA) were inserted in 90 patients. 112 untreated catheters placed in 96 patients served as controls (n = 62 acute catheters, n = 58 long-term catheters). After removal, the catheters were cultured for bacterial colonization using standard microbiologic assays. They also were examined using a scanning electron microscope (SEM). Bacterial colonization was observed in 8% of the treated catheters compared with 46.4% of untreated catheters. The SEM investigations showed all treated catheters to possess low thrombogenicity. Results of the study indicate that ion beam based processes can be used to improve thrombus and infection resistance of blood contacting catheters.

Surface-Treated versus Untreated Large-Bore Catheters as Vascular Access in Hemodialysis and Apheresis Treatments

“…The clinical results of our preliminary investigations showed a significantly reduced infection rate in treated versus untreated catheters, a reduction of more than 75% [28]. With the silver surface treatment, a very smooth metallic surface was obtained, which was responsible for a lower thrombogenicity rate.…”

“…This requirement shows perhaps the new developed catheter material, the microdomain-structured surface (PUR-SMA-coated catheters, Gambro, Germany) [28]. Microdomain surfaces are considered the most biocompatible because they mimic the structure of natural biological surfaces.…”

“…Also, bacterial colonization and thrombus accumulation and the cuffs of the catheters after fixation were also investigated. In a preliminary study from 2001, the authors found a decline of the infection rate with the surface-treated catheter [28]. To examine these results in a 15-year study is the aim of this paper.…”

Silver Coating of Dialysis Catheters to Reduce Bacterial Colonization and Infection

“…Clinical studies of efficacy have generally shown significantly lower bacterial colonization on tips of catheters coated with silver. Two clinical studies, each involving well over 100 patients (16,17), demonstrated bacterial colonization rates that were 3–4 times lower on silver‐coated catheters than on comparable control catheters. Smaller scale studies have shown comparable reductions.…”

“…Several clinical studies have been conducted to assess efficacy of silver‐coated dialysis catheters. In the largest published clinical study to date, Bambauer et al evaluated bacterial contamination of silver‐coated and uncoated catheters as part of a 186‐patient prospective study (16). Eighty‐five IBAD silver‐coated catheters (39 acute, 46 long‐term) and 112 untreated catheters (62 acute, 50 long‐term) were evaluated over a 4‐year period.…”