Subclavian Hemodialysis Catheter Infections: A Prospective, Randomized Trial of an Attachable Silver-impregnated Cuff for Prevention of Catheter-related Infections

Objective: To determine if an attachable silver-impregnated cuff is effective in reducing subclavian hemodialysis catheter-related infections. Design: Prospective, randomized, nonblinded study. Setting: Community teaching hospital. Patients: One hundred one acute and chronic renal failure patients requiring subclavian venipuncture and catheterization. After randomization, 47 patients underwent subclavian catheterization with a silver-impregnated cuff (Ag-CC), and 54 patients had routine catheter (RC) placements. Measurements: Multiple presumed predictor variables for catheter-related infections, exit site infection rate, bacteremia rates, and semiquantitative cultures of all catheters. Results: There were no significant differences between the AG-CC and the RC groups for catheter colonization, exit site infection, catheter sepsis, any catheter-related infections, or the incidence of infections within the first 7 or 14 days. Although the differences did not achieve statistical significance, the RC group was more likely to experience catheter colonization (20.4% versus 14.9%) and exit site infection (5.6% versus 2.1%). However, the RC group contained nearly twice as many intensive care (ICU) patients (44% versus 23%; P=.027), and ICU subjects were twice as likely to acquire catheter infection (P<.002). Conclusions: Although the sample size was insufficient to exclude Type 2 errors, it appears that the attachable silver-impregnated cuff did not reduce subclavian catheter-related infections in our patient population.