Discussion

Concerns of incompatible antiseptic and disinfectants are commonly raised by catheter manufacturers, clinic staff and even regulatory agencies such as the CDC [10]. The frequency of reported complications is low, however, this does not mean catheter degradation is not a common problem in the clinics, only that it is not commonly reported.

It is common that a clinic will have many patients from several different nephrologists, different hospitals and different interventional radiologist or surgeons. It is therefore, very likely that there will be several different catheters from different manufacturers and of different materials. This is where the risk of degradation is greatest since identifying the catheter material is not a simple feat.

The catheter manufacturers provide a list of compatible antiseptics and disinfectants in their instructions for use. However, the name of the catheter and manufacturer are not commonly found on the catheter making identification

Strain (mm, Elongation) Fig. 4. Bard Hemoglide® Tecoflex® catheter in different disinfectants.

nearly impossible. Recently, some manufacturers are putting contraindicated solution markers on the actual catheter extensions to help minimize the risk of using the wrong solution and damaging the catheter.

As mentioned previously, the catheter manufacturers perform their own testing on the compatibility of their catheters with different solutions. This testing follows the ISO 10555-1 standards and consists of measuring the force that is required to break a catheter at each segment, separately. The minimum force acceptable is a force between 3 and 15 N, dependent on outside diameter of test piece. To evaluate the affects of disinfectants, the catheters are tested after being placed in solution for either extended periods of time, ex. 48 h, or placed in solution for 10 min and then removed with this step repeated every other day for 60 days, simulating actual use.

Since it has already been proven, by the dialysis catheter manufacturers, that ExSept and Alcavis 50 ESH are compatible solutions with all types of materials, this study aimed to evaluate the physical affects of different solutions

Normal saline Alcavis 50% Isopropyl alcohol 70%

Strain (mm, Elongation)

Fig. 5. Bard Hickman® Silicone catheter in different disinfectants.

on the different catheter materials. This was performed by soaking the catheters for 48 h in solution, then rinsing with saline and recording the displacement to force curves for different catheters and materials. A possible limitation of this study is that the catheters were placed in solution and filled with the solution for a period of 48 h. Normally, the antiseptic or disinfectant is in contact with the catheter for a period of not more than 10 min and then air dried. This step is then repeated every other day for as long as the catheter is in place. In addition, the inner lumen of the catheter is rarely exposed to the antiseptic/disinfectant solution (lock solutions were not evaluated in this study). However, a 48 h soak is a similar contact time to 28,810-min exposures and is, therefore, an acceptable challenge to the catheter material.

It has been clearly demonstrated in this study that ESH solutions are the only solutions that do not alter the physical properties of any of the catheters after long-term exposure. This was evident by the less than 10% deviation in the resultant displacement vs. force curves measured compared to a saline exposed control. Alcohol was clearly compatible with silicone catheters, however appears to affect the physical properties of both polyurethane based catheters.

The Tecoflex catheters do list alcohol containing solutions as contraindicated. The Carbothane catheters, which exhibited a similar deviation when exposed to alcohol, do not list alcohol as a contraindication. This is because, even though there were physical changes with alcohol exposure, the strength of the catheter was well within the ISO guidelines. The strength of Carbothane and compatibility with different solutions was also confirmed by Ash [15].

Given that ESH solutions have been shown in this study, by the manufacturers of the dialysis catheters and by decades of historical use, to be compatible with all catheter types and all catheter materials, it would be best practice to incorporate ExSept and Alcavis 50 into routine catheter site and catheter care. ESH solutions will permit ease of mind in catheter compatibility as well as safety and effectiveness as an antiseptic and disinfectant for dialysis patients throughout the world.

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