A PROSPECTIVE RANDOMIZED COMPARISON OF AN ATTACHED SILVER-IMPREGNATEDCUFF TO PREVENT CENTRAL VENOUS CATHETER-ASSOCIATED INFECTION

The VitaCuff catheter, a specialized central venous catheter (CVC) wit h an attached silver-impregnated cuff, is designed to permit percutane ous placement and prolonged venous access. A prospective randomized st udy was undertaken comparing the VitaCuff with standard triple lumen c atheters to determine if the VitaCuff reduces infection during extende d use. All consenting patients underwent percutaneous placement of sub clavian lines. By study design, control and VitaCuff catheters could r emain in site for up to 7 and 14 days, respectively. Cultures were obt ained from the preinsertion skin site, and upon removal, from the skin , hubs, infusates, CVC tip, and cuff. Statistical methods included chi (2), the Student t test, and the log-rank test on Kaplan-Meier estimat es. Of 133 patients completing this study, 64 patients (48.1%) underwe nt VitaCuff placement and 69 patients (51.8%) served as controls. In 1 24 patients (93.2%), the indication for catheter placement was for per ioperative care. Overall, 67 patients (50.4%) required central venous access >7 days, necessitating greater than or equal to 1 additional li ne in 29 patients (21.8%). The incidence of pneumothorax per patient f rom the initial central line insertion was 4/104 (3.85%), significantl y lower than the 4/29 (13.8%) incidence during secondary catheter plac ement (P = 0.046). Culture results upon catheter removal demonstrated a reduction in colonization of skin sites and hubs for the VitaCuff pa tients, but not for catheter tips or infusates. Regardless of the type of catheter used, colonization was dependent upon duration of inserti on. The incidence of catheter-related sepsis was 6.8%, and did not dif fer significantly between the study groups. Multiple CVC insertions in crease the incidence of pneumothorax. Because VitaCuff catheters permi t extended access up to 14 days without increasing the incidence of se psis, we recommend their use in patients who require prolonged CVC acc ess. (C) Academic Press, Inc.