The influence of an attachable subcutaneous cuff for preventing triple lumen catheter infections in critically ill surgical and trauma patients.

One hundred and ninety-one triple lumen central venous catheters were placed into 107 sites in 81 surgical and trauma patients who were prospectively studied to determine the rate of catheter related infection using a subcutaneous cuff of biodegradable collagen containing bactericidal silver and a guide wire exchange protocol. Thirty-seven sites in 36 nonseptic patients (group 1) were compared with 70 sites in 45 septic patients (group 2). The data were also compared with data consecutively collected one year earlier, using the same exchange protocol without the cuff. Fourteen of 70 sites in group 2 had catheter related infections, with seven causing bloodstream infection. Five of 14 were the result of fungus, with three causing fungemia. Two of 37 sites in group 1 had catheter related infections (p = 0.044), with no associated bacteremia. The number of triple lumen catheter related infections and associated bacteremia or fungemia are higher in septic patients compared with nonseptic critically ill surgical and trauma patients. The cuff significantly prolongs time of catheter site use in patients who are nonseptic, but may be of no benefit in reducing infection rates or prolonging site use time in patients who are septic and may predispose to fungal colonization.