Hub Region Disinfecting Nitric Oxide Releasing Insert for Tunnel Dialysis Catheters.

The use of tunneled dialysis catheters (TDCs) for patients in need of hemodialysis treatments (HDs) cause a significant number of blood stream infections (BSIs), with very few viable preventative/treatment methods. Use of antibiotics are relatively ineffective due to the development of multi-drug resistant bacterial strains and their inability to penetrate bacterial biofilms. Nitric oxide (NO) is an endogenous gas molecule that has broad spectrum antimicrobial/anti-biofilm activity. In this study, the potential of creating a NO releasing insert device that is attached onto the hub region cap of TDCs and locally releases NO within the TDC hub is evaluated for its antimicrobial/anti-biofilm effectiveness. The NO releasing insert contains the natural NO donor S -nitrosoglutathione (GSNO) along with zinc oxide (ZnO) nanoparticles to accelerate NO release from the GSNO, within a short silicone tube that is sealed at both ends and attached to the catheter cap. An in vitro 3 d long antimicrobial study using catheter hubs yielded >6.6 log reductions of both P. aeruginosa and S. aureus for the NO releasing insert device compared to controls. Two 14 d long sheep studies demonstrated that the NO releasing insert devices are exceptionally potent at preventing bacteria/biofilm growth on the inner lumen walls of TDCs compared to controls that have no preventative treatment devices as well as implanted TDCs that have commercially available chlorhexidine treated insert devices placed within the hub regions.