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

Abstract

Background. Catheter-related infections, thrombosis, and stenosis are among the most frequent complications associated with catheters, which are inserted in vessels. Surface treatment processes of the outer surface, such as ion-beam-assisted deposition, can be used to mitigate such complications. Methods. This retrospective study (1992–2007) evaluated silver-coated (54 patients) and noncoated (105 patients) implanted large-bore catheters used for extracorporeal detoxification. The catheters were inserted into the internal jugular or subclavian veins. After removal, the catheters were cultured for bacterial colonization using standard microbiologic assays. They also were examined using scanning electron microscope. Results. The silver coated catheters showed a tendency towards longer in situ time. The microbiologic examinations of the catheter tips were in both catheter types high positive, but not significant. Conclusion. The silver-coated catheters showed no significantly reduction in infection rate by evaluation of all collected data in this retrospective study. There was no association between both catheters in significantly reducing savings in treatment costs and in reducing patient discomfort. Other new developed catheter materials such as the microdomain-structured inner and outer surface are considered more biocompatible because they mimic the structure of natural biological surface.

Quantification of Fibrin in Blood Thrombi Formed in Hemodialysis Central Venous Catheters: A Pilot Study on 43 CVCs

“…The National Kidney Foundation guidelines from the ‘Dialysis Outcomes Quality Initiative’ set the lower limit to 300 mL/min for extracorporeal blood flow to properly treat the patient without excessive duration of the procedure (3–5). Insufficient blood flow is a signal of catheter malfunction, frequently related to thrombotic obstructions (1, 2, 4, 6, 7). Intraluminal catheter thrombi occur when a blood clot partly or completely occludes the lumen or catheter holes.…”

“…Fibrin is composed of fibrinogen, albumin, lipoproteins and coagulation factors. A fibrin sheet around the CVC is documented to form within 24 hours from CVC insertion (3, 4, 6, 7). The fibrin sheath attracts platelets and coagulation factors and promotes leukocyte adherence.…”

Surface Treated Catheters for Vascular Access—Useful?

“…The preliminary results with these PUR-SMA coated catheters showed a good biocompatibility without any blood deposits and a low thrombogenicity and coagulation activity. The microbiological results were low and of those from the Spi-Argent ® catheters [30]. tributing factor to a successful clinical outcome, particularly in catheters that remain in situ for several weeks or months.…”

“…In the median catheters were used for 44 (range, 1 -670) treatment sessions. Untreated catheters were used for 51 (range, 1 -625) treatments, silver coated catheters for 39 (range, 1 -670, p = 0.849) treatment sessions [30].…”

“…The exclusion criteria were a pregnant or lactating female, a hypersensitivity of silver and a bacteremia at the time of catheter insertion. An IRB approval was in 1992 not necessary [30]. After the patients had given their consent to this study, the physician chose the catheter which he inserted after a randomization of one surface treated catheter, and than two untreated catheters, and so on.…”