Chlorhexidine-coated peripherally inserted central catheters reduce fibroblastic sleeve formation in an in vivo ovine model

Sylvia, Charles J; Wagel, Molly A; Giare-Patel, Kamna; Spangler, Taylor; Breznock, Eugene M.; Gupta, Nisha

doi:10.1177/1129729818769033

Cited by 13 publications

(22 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thus, CRT formation is promoted by the vicious cycle of thrombus and infection, and the results of this study suggest that chlorhexidine may stop this vicious cycle. In a previous study, a chlorhexidine-coated catheter significantly reduced fibrin sheath formation around the catheter 22 . The fibrin sheath enhances catheter colonization and catheter-related infection 26 .…”

Section: Discussionmentioning

confidence: 73%

“…It is expected that the inhibition of this adhesion will reduce thrombus around the catheter. Further chlorhexidine minimizes thrombus accumulation on the catheter surface by the inhibition of thrombin 22 . Thus, CRT formation is promoted by the vicious cycle of thrombus and infection, and the results of this study suggest that chlorhexidine may stop this vicious cycle.…”

Section: Discussionmentioning

confidence: 99%

“…Type A comprises a PMEA-coated CVC that is used for pump oxygenators, and it has a high level of biocompatibility 30 . The PEMA-coated catheter prevented the attachment of fibrin sheath and thrombus to the catheter 22,31 . This result on the PEMA-coated catheter in this study may have been affected by the number of patients with late CRT.…”

Section: Discussionmentioning

confidence: 99%

“…This study showed that CGCD effectively reduced the incidence of CRT within 7 days compared with PITD. The pathogenesis of CRT is complex and poorly understood; CRT is composed of cellular elements, such as smooth muscle cells, endothelial cells, and noncellular elements, such as fibrin and fibronectin 20 – 22 . The reason for the decrease in CRT in the CGCD group in this study may be due to the antibacterial and antithrombotic effects of chlorhexidine.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Early prophylaxis of central venous catheter-related thrombosis using 1% chlorhexidine gluconate and chlorhexidine-gel-impregnated dressings: a retrospective cohort study

Yamashita

Takamori

Nakagawachi

et al. 2020

Sci Rep

View full text Add to dashboard Cite

To determine the prophylactic effect of using combined 1% alcoholic chlorhexidine gluconate and chlorhexidine gel-impregnated dressings (CGCD) on catheter-related thrombosis (CRT) in critically ill patients. This retrospective cohort study was performed in an intensive care unit from November 2009 to August 2014. The CRT incidence diagnosed with ultrasound examination was compared between patients applying CGCD and combined 10% aqueous povidone-iodine and standard transparent dressings (PITD) after central venous catheter insertion into the internal jugular vein for ≥ 48 h. CRT was stratified into early (within 7 days) and late (days 8–14) thromboses. Multivariate analyses using logistic regression models clarified the relationships between early- and late-CRT risks and skin antiseptic and catheter site dressing combinations. CRT occurred in 74 of 134 patients (55%), including 52 with early CRT and 22 with late CRT. Patients receiving CGCD had a significantly lower incidence of early CRT than those receiving PITD (odds ratio = 0.18; 95% confidence interval = 0.07–0.45, p < .001). No significant association was evident between using CGCD and late CRT (p = .514). Compared to PITD, CGCD reduced the CRT risk over 7 days in critically ill patients. UMIN Clinical Trials Registry: UMIN000037492.

show abstract

Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Early prophylaxis of central venous catheter-related thrombosis using 1% chlorhexidine gluconate and chlorhexidine-gel-impregnated dressings: a retrospective cohort study

Yamashita

Takamori

Nakagawachi

et al. 2020

Sci Rep

View full text Add to dashboard Cite

show abstract

“…1 Fibroblastic sheaths were said to be responsible of 13%–57% of malfunctions in cuffed catheters for hemodialysis. 2 The phenomenon is explained as part of a foreign-body reaction in which fibronectin is initially deposited around the catheter; 3 later, collagen and cellular activation (with calcium deposition) modify the composition of the sleeve; extensive analysis of the formation led to the term “fibroblastic sheath” being abandoned for the current one. 3 When the sleeve is calcified it appears as a “cast,” as it has been described by several works, 4–6 and it is easy to misinterpret it as a catheter fragment.…”

Section: Resultsmentioning

confidence: 99%

If it looks like a catheter and winds like a catheter . . . fibroblastic sheath mimicking a central venous catheter fragment: A case report

et al. 2019

View full text Add to dashboard Cite

Introduction: Fibroblastic sheath formation is a well-known complication of long-term central venous catheters. When calcified, fibroblastic (formerly known as “fibrin”) sheaths may be easily mistaken for retained catheter fragments. We describe one such case and how imaging was used to recognize the sheath and avoid unnecessary interventions. Case Description: A patient with systemic sclerosis was referred for port removal because of suspected infection. A later computed tomography scan showed a persistent tubular structure coursing behind the right clavicle, which was also seen in an anteroposterior chest radiograph. Three-dimensional reconstruction and analysis of the structure’s lumen in comparison to previous imaging studies allowed us to confirm that it was, in fact, a calcified fibroblastic sheath. The patient’s course was uneventful thereafter. Conclusion: Three-dimensional computed tomography reconstruction, as well as the hollow appearance of a tubular structure after removal of a central catheter may help differentiate a fibroblastic sheath from a retained catheter fragment. Accurate surgical notes mentioning the length of the catheter at implant and explant are also of paramount importance.

show abstract

Comparison of 2 Midline Catheter Devices With Differing Antithrombogenic Mechanisms for Catheter-Related Thrombosis

et al. 2021

View full text Add to dashboard Cite

IMPORTANCEData regarding upper extremity midline catheter (MC)-related thrombosis (CRT) are sparse, with some evidence indicating that MCs have a high rate of CRT. OBJECTIVE To compare 2 MCs with differing antithrombogenic mechanisms for this outcome. DESIGN, SETTING, AND PARTICIPANTS In this parallel, 2-arm randomized clinical trial, 496 adult patients hospitalized at a tertiary care suburban academic medical center who received an MC were assessed for eligibility between January 1, 2019, and October 31, 2020, and 212 were randomized. INTERVENTIONS Inpatients were randomized to receive a 4F antithrombotic MC (MC-AT) or a 4.5F antithrombotic and antimicrobial MC (MC-AT-AM). MAIN OUTCOMES AND MEASURES The primary outcome was symptomatic midline CRT inclusive of deep vein thrombosis or superficial venous thrombophlebitis within 30 days after insertion. Secondary outcomes included catheter-associated bloodstream infection and catheter failure. RESULTS A total of 191 patients (mean [SD] age, 60.2 [16.7] years; 114 [59.7%] female) were included in the final analysis: 94 patients in the MC-AT group and 97 in the MC-AT-AM group.Symptomatic midline CRT occurred in 7 patients (7.5%) in the MC-AT group and 11 (11.3%) in the MC-AT-AM group (P = .46). Deep vein thrombosis occurred in 5 patients (5.3%) in the MC-AT group and 5 patients (5.2%) in the MC-AT-AM group (P > .99). Pulmonary embolism occurred in 1 patient in the MC-AT group. No catheter-associated bloodstream infection occurred in either group. Premature catheter failure occurred in 22 patients (23.4%) in the MC-AT group and 20 (20.6%) in the MC-AT-AM group (P = .64). In Cox proportional hazards regression analysis, no statistically significant difference was found between groups for the risk of catheter failure (hazard ratio, 1.27; 95% CI, 0.67-2.43; P = .46). CONCLUSIONS AND RELEVANCENo difference was found in thrombosis in MCs with 2 distinct antithrombogenic mechanisms; however, the risk of CRT in both groups was high. Practitioners should strongly consider the safety risks associated with MCs when determining the appropriate vascular access device.

show abstract

Chlorhexidine-coated peripherally inserted central catheters reduce fibroblastic sleeve formation in an in vivo ovine model

Cited by 13 publications

References 25 publications

Early prophylaxis of central venous catheter-related thrombosis using 1% chlorhexidine gluconate and chlorhexidine-gel-impregnated dressings: a retrospective cohort study

Early prophylaxis of central venous catheter-related thrombosis using 1% chlorhexidine gluconate and chlorhexidine-gel-impregnated dressings: a retrospective cohort study

If it looks like a catheter and winds like a catheter . . . fibroblastic sheath mimicking a central venous catheter fragment: A case report

Comparison of 2 Midline Catheter Devices With Differing Antithrombogenic Mechanisms for Catheter-Related Thrombosis

Contact Info

Product

Resources

About