Intravenous literature: Kakkos, S.K., Kournoian, J. and Haddad, G.K. (2013) A Comparative Study of the Sapphire and Equistream Hemodialysis Tunneled Cuffed Catheters. The Journal of the Association for Vascular Access. 18(1), p.37-44.
Background: Tunneled cuffed catheters (TCCs) for hemodialysis are plagued by high dysfunction and infection rates and research toward improved products is extremely important to improve hemodialysis quality. The aim of our study was to compare 2 different TCC types.
Methods: Two hundred seventy-six TCCs in 246 patients referred for new TCC placement or exchange of a pre-existing TCC over a guide wire were studied, including 144 Equistream TCCs (Bard Access Systems, Salt Lake City, UT) and 132 Sapphire TCC historical controls (Covidien, Mansfield, MA). The 2 study groups were mostly comparable in terms of baseline characteristics.
Results: Primary assisted patency (PAS) at 6 months with the Equistream and Sapphire TCCs was 80.6% and 81.3%, respectively (p=0.45). PAS at the internal jugular site was better than the femoral site (86.3% and 66.7%, respectively) at 3 months (p<0.001), with no difference between TCC type. TCC material failure-free rate at 6 months with the Equistream and Sapphire TCCs was 93.5% and 98.1%, respectively (p=0.20). TCC material failure-free rate at 6 months after TCC exchange for dysfunction compared with the remaining cohort was 85.2% versus 98.9%, respectively (p<0.001). For the Equistream and Sapphire TCC subgroups, these rates were 66.0% and 100% (p<0.001), and 100% and 97.6% (p=0.43), respectively.
Conclusions: The 2 catheter types are equivalent in terms of PAS. The use of historical controls necessitates confirmation by a randomized controlled trial, whereas the mechanical problems of the Equistream TCCs deserve further investigation.