Improved effectiveness of a New Tunneled Catheter (Tal Palindrome^TM Ruby) in Preventing Catheter Malfunction

OBJECTIVES: To evaluate two different types of antimicrobial-eluting tunneled cuffed catheters (TCCs) for hemodialysis.
METHODS: One hundred HemoSplit TCCs with BioBloc (silver sulfadiazine) coating that have a unique split distal tip design (Bard Access Systems, Inc., Salt Lake City, Utah) and 100 Tal Palindrome Ruby TCCs (Tyco Healthcare/Kendall, Mansfield, Mass), that have a silver antimicrobial sleeve permanently bonded to the external surface of the catheter and a unique spiral-z tip design were compared in this case-controlled study.
RESULTS: Primary assisted TCC patency was significantly reduced in the Bioblock (71% and 61%, at 90 and 180 days, respectively) compared to the Palindrome Ruby TCCs (94% at 90 and 180 days, P<.0001). Multivariate analysis identified only TCC type (Bioblock TCC) and common femoral access site as independent predictors of worse patency. The unadjusted relative risk (95% ci) for TTC dysfunction with the Bioblock TCC, compared to the Palindrome Ruby TCC, 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 Bioblock (84% and 68%, at 90 and 180 days, respectively) and Palindrome Ruby TCCs (81% and 62%, at 90 and 180 days, respectively) were similar (P=.36). The presence of infection around TCC placement or exchange (more common in the Palindrome Ruby TCCs than the Bioblock TCCs) was associated with a significantly increased TCC re-infection rate (P<.0001). The reintervention-free rate for infection or malfunction was significantly better in the Palindrome Ruby (76% and 58%, at 90 and 180 days, respectively) compared to the Bioblock catheters (60% and 45%, at 90 and 180 days, respectively, P=.03), however access site loss free survival was similar in the two groups (83% and 81% at 180 days for the Bioblock and Palindrome Ruby TCC, respectively, P=.59).
CONCLUSIONS: Our results support the use of the Palindrome Ruby TCC based on the significantly lower thrombosis and re-intervention rate. Randomized trials are justified to confirm this and evaluate its role in preventing TCC infection.