vascular access infection prevention
Reducing Catheter Occlusions and Failure
Catheter occlusion and related complications are estimated to affect nearly 80 percent of peripheral and central vascular access catheters ( Steere , 2018 ). Obstruction complications include loss of patency , phlebitis , and infiltration in PIV catheters . Blood is the first body fluid which touches vascular access catheter materials , such as urethane and Teflon . When the synthetic catheter material meets blood , a layer of plasma proteins absorbs onto the catheter surface and triggers a complex series of biological responses including protein absorption , platelet adhesion , coagulation and thrombosis .
The thrombotic deposits of platelets and fibrin mesh that develop within and around catheters are the result of a natural process that impact catheters upon insertion and throughout treatment as the catheter is used for infusions and blood draws . When blood is pulled back into the catheter , intentionally or functionally , during syringe connection / disconnection , patient movement , or pressure changes , red blood cells adhere to the inside of the catheter creating suboptimal flow . Such occlusions can lead to patency loss and device replacement or removal , all of which can negatively impact therapeutic outcomes . Blood coagulation and platelet adhesion to intraluminal catheter surfaces remain one of the largest contributors to vascular access catheter dysfunction by producing partial and total IV catheter occlusion .
Other complications associated with build-up within a catheter include vein thrombosis , venous inflammation , and catheter-related bloodstream infections ( CRBSIs ). Reflux of blood into the catheter , especially small diameter catheters , contributes to partial and complete occlusions , has a relationship to catheter associated infection , and may be a contributing factor in venous thrombosis development . Preventing occlusions , then , becomes a chain of events that presents an opportunity for improving both patient outcomes and catheter function that impacts healthcare facilities ’ bottom line .
The literature contains studies that have examined various methods to reduce catheter failure caused by blood reflux including the use of thrombolytics ( Dillon , et al . 2008 ; Ernst , et al . 2014 ; Helm , 2015 and 2019 ). Other studies have sought to evaluate the impact of blood reflux-controlling valves on occlusions and infiltrate complications ( Jasinsky , 2009 ; Johnston , et al . 2014 ; Steere , et al . 2018 ). Still others have examined the various design features of how valves function to limit or eliminate blood reflux into catheters ( Steere , 2016 ; Schilling , et al . 2006 ). A Cochrane Protocol published in 2019 established reflux-controlling valve function by outlining a systematic review process for validating catheter materials and reduced complications ( Schults , et al . 2019 ).
According to Rosenthal , in 2020 , anti-reflux needlefree connector designs incorporate a bidirectional fluid-control valve designed to restrict fluid movement on connection and prevent
unplanned reflux into the intravascular catheter during infusion , connection , disconnection and patient changes in intra-thoracic pressure . A reflux-controlling valve is an internal mechanism engineered into catheters and / or needleless connectors ; these valves are designed to control fluid movement , most notably to prevent backwards flow . Design and performance vary by device type . Whether the valve technology is integrated into the catheter , or integrated into the needleless connector technology , these devices reduce clinician dependency on proper clamping sequence that blocks reflux and greatly reduces the blood movement from physiological pressure changes that naturally occur inside the patient ’ s vasculature . More research is needed to establish more substantial conclusions on occlusion causation , the
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When the synthetic catheter material meets blood , a layer of plasma proteins absorbs onto the catheter surface and triggers a complex series of biological responses including protein absorption , platelet adhesion , coagulation and thrombosis .