By Nancy Moureau , PhD , RN
Materials Matter : Change the Material ,
Change Outcomes
Intravenous ( IV ) catheters are the most commonly placed medical devices used in acute care . More than 340 million peripheral catheters ( PIVC ) and 5 million central venous catheters ( CVCs ) are placed in patients in the United States annually ( iData , 2020 ; O ’ Grady et al , 2011 ). Preventing complications related to these catheters is a continuous costly and time-consuming challenge . Constant surveillance , vigilant management , and regular education are required to reduce complications . Two of the most serious complications seen in IV catheters are infections and thrombosis . Exploring existing and emerging catheter material technologies has been a focus of research since the 1980s and now , with new composition materials outperforming coated catheters the outcomes are demonstrating greater promise at reducing these most serious complications based on catheter materials alone .
CVC infections known as central line-associated bloodstream infections ( CLABSIs ) are the focus of much attention related to reporting requirements and the effect on reimbursement . The COVID 19 pandemic had a negative effect on CLABSI incidence increasing rates by 47 percent in all location types ( CDC , 2022 ). More than 700 hospitals faced penalties related to bloodstream infections under Medicare ’ s Healthcare-Acquired Condition ( HAC ) reduction program ( Sullivan , 2021 ).
The second serious complication affecting CVCs , and specifically peripherally inserted central catheters ( PICCs ), is upper extremity thrombosis ( UEDVT ) with rates ranging from 2.7-77.2 percent ( Zohourian et al . 2019 , Paauw et al . 2008 , Heil et al ., 2017 ). PICCs are one of the most commonly used CVCs and have a 2.6-fold greater chance of associated UEDVT than all other CVCs ( Chopra et al ., 2013 ). Additional cost and length of stay attributed to PICC-associated UEDVT were $ 15,973 with additional hospital days of 4.6 making this a complication that requires consideration for improvement strategies ( Evans et al ., 2013 ). Relationship of Thrombosis and Infection The IV access requirement for delivery of medications and solutions constitutes a risk factor for infection . Insertion of an intravenous catheter into a patient creates an opening in the body ’ s skin barrier , introduces foreign material into the body with subsequent trauma to the vein . This break in the skin barrier increases the risk of bacterial entry into the bloodstream of the patient ’ s own skin flora or from other contaminants present in the healthcare environment to enter the vascular system . Additionally , the normal foreign body response initiated with catheter placement sets off a cascade of reactions with blood proteins and host cells intended to engulf the foreign material . As blood proteins adhere to the catheter , they provide a breeding ground for bacteria . Any introduction
Exploring existing and emerging catheter material technologies has been a focus of research since the 1980s and now , with new composition materials outperforming coated catheters the outcomes are demonstrating greater promise at reducing these most serious complications based on catheter materials alone .”
www . healthcarehygienemagazine . com • september 2022
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