Given that intravenous catheters are a mainstay for current medical treatment , many strategies have been applied in the quest to reduce infection and thrombosis , from education to the development of various types of catheter materials that limit infection and resist blood cell and bacterial adherence .” of contaminants , during insertion or post insertion , presents an immediate challenge in the form of both infection and thrombosis , working in synchrony . As bacteria grows and flourishes on the surface of the catheter , protein and host cell aggregation increases promoting catheter related thrombosis .
The relationship between infection and thrombosis is well established in the literature ( Smeeth et al . 2006 , Cohoon et al . 2017 , Liu et al . 2018 ). Systemic , or localized , infections increase the risk of thrombosis up to 20 times and function as an independent factor for risk of deep vein thrombosis ( Beristain-Covarrubias et al , 2019 ). Timsit and colleagues note that colonization rates are almost double in catheters with thrombosis ( 32 percent vs . 19.4 percent ); catheter sepsis rates are more than double ( 19 percent vs . 7 percent ); and septicemia rates are more than triple ( 11.6 percent vs . 3.6 percent ) when thrombosis is present ( Timsit et al ., 1998 ). As the body ’ s own response to the insertion of foreign materials into the bloodstream initiates thrombotic formation and opportunities for the development of infection , infection , independent of coagulation factors , contributes to thrombosis development as a two-way inter-related set of complications .
Why Materials Matter
Given that intravenous catheters are a mainstay for current medical treatment , many strategies have been applied in the quest to reduce infection and thrombosis , from education to the development of various types of catheter materials that limit infection and resist blood cell and bacterial adherence .
Silicone catheter materials predominate intravenous catheter types in the 1970s and were initially thought to be highly biocompatible and durable . We now know that silicone catheters have a higher degree of thrombogenicity with lower tensile strength and therefore are more prone to rupture , leakage , occlusion , and sepsis ( Kohnen and Jansen 1995 , Mehall et al . 2001 ).
Polyurethane catheters were introduced in the 1980s . While first-generation polyurethane catheters had various levels of irritation and material cracking , the third-generation polyurethanes have established a balance of durability and biocompatibility , in addition to withstanding high pressure injection ( Seckold et al ., 2015 ). Both silicone and polyurethane have varying degrees of protein and cellular adherence . Regardless of the type of material used for intravenous catheters blood cell adherence occurs within minutes of insertion of polyurethane or silicone catheters into the bloodstream .
The two major approaches have been incorporated into new catheters with properties that function with antimicrobial action and hydrophilic protein resistant surfaces ( Casimero et al ., 2020 ). Antimicrobial catheter surfaces aim to eliminate bacteria on contact and hydrophilic functions prevent bacteria and proteins from adhering to the catheter . Antimicrobial catheters have been recommended within multiple guidelines including the Centers for Disease Control and Prevention ’ s Healthcare Infection Control Practices Advisory Committee ( HICPAC ) for the use chlorhexidine-silver sulfadiazine ( CSS ) or minocycline-rifampicin ( MR ) impregnated catheters ( O ’ Grady et al ., 2011 ; Hockenhull , 2008 ). The use of antiseptic coated catheters has been shown to decrease , not eliminate , infection with short term catheters but the efficacy with regards to long term catheters is unclear ( Zhang et al ., 2013 ). Ullman and colleagues concluded from a study involving PICC lines in 42,562 patients , that antimicrobial catheters did not show a reduction in infection ( Ullman et al ., 2022 ). Thrombotic and infectious complications continue to be a challenge leading to the need for further enhancements , despite the addition of antimicrobial catheter properties .
Keeping abreast of the literature on current and evolving catheter material technology is an important activity in today ’ s healthcare environment . New materials may have the potential to mitigate some of the labor- intensive activities involved in reducing intravenous catheter complications . The potential to protect patients proactively while the catheter is indwelling makes materials matter . Prevention of thrombosis , catheter occlusion and infection continue to be high priorities for safeguarding patients and maintaining catheter function for therapy infusions .
Nancy Moureau is the owner of PICC Excellence , Inc a company committed to education , research and application of best practices . She is a member of the Alliance for Vascular Access Teaching and Research ( AVATAR ) at Griffith University and a clinician with Infinity Infusion Nursing .
References :
Beristain-Covarrubias N , Perez-Toledo M , Thomas MR , Henderson IR , Watson SP , Cunningham AF . Understanding infection-induced thrombosis : lessons learned from animal models . Frontiers in immunology . 2019 Nov 5 ; 10:2569 . doi : 10.3389 / fimmu . 2019.02569
Casimero C , Ruddock T , Hegarty C , Barber R , Devine A , and Davis J . ( 2020 ). Minimizing bloodstream infection : developing new materials for intravascular catheters . Medicines , 7 ( 9 ), 49 .
CDC . ( 2022 , June 10 ). COVID-19 Impact on HAIs . Centers for Disease Control and Prevention . Available at : https :// www . cdc . gov / hai / data / portal / covid-impact-hai . html
Chopra V , Anand S , Hickner A , Buist M , Rogers MA , Saint S , and Flanders SA . ( 2013 ). Risk of venous thromboembolism associated with peripherally inserted central catheters : a systematic review and meta-analysis . The Lancet , 382 ( 9889 ), 311-325 .
Cohoon KP , Ashrani AA , Crusan DJ , Petterson TM , Bailey KR , Heit JA . Is infection an independent risk factor for venous thromboembolism ? A population-based , case-control study . Am J Med . ( 2018 ) 131:307 – 16 . e2 . doi : 10.1016 / j . amjmed . 2017.09.015
Evans RS , Sharp JH , Linford LH , Lloyd JF , Woller SC , Stevens SM , Elliott CG , Tripp JS , Jones SS , and Weaver LK . ( 2013 ). Reduction of peripherally inserted central catheter-associated DVT . Chest , 143 ( 3 ), 627 – 633 . https :// doi . org / 10.1378 / chest . 12-0923
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