Surface-treated catheters--a review.

Almost 30% of prevalent hemodialysis patients use catheters for vascular access although outcomes are superior with the use of either an arteriovenous fistula or a synthetic graft. Catheter complications are a major cause of morbidity and mortality for hemodialysis patients and increase the burden on the health care system. Surface-treated catheters have been developed to combat the three most common causes of catheter failure: infection, fibrin sheath formation, and thrombus formation. Two types of catheter surface treatments are available: antimicrobial coatings and antithrombotic coatings. Surface treatment of central venous catheters with antimicrobial materials reduces both bacterial colonization and the incidence of catheter-related bacteremia in critical care patients by 30-50%. Antithrombotic coatings reduce platelet adhesion, inhibit the inflammatory response, and reduce thrombus formation on coronary stents, ventricular assist devices, central venous catheters, and vascular grafts. However, few reports on the use of surface-treated catheters in the chronic hemodialysis patient population exist. At the present time, it is difficult to justify the increased cost of surface-treated catheters for chronic hemodialysis in the absence of clinical data demonstrating that they reduce catheter-related complications in this patient population.