Clinical experience with a chlorhexidine-coated PICC: A prospective, multicenter, observational study

Abstract

Introduction: This study evaluated a chlorhexidine-coated peripherally inserted central catheter (PICC) and the incidence of associated complications within both inpatient and outpatient populations. Methods: This IRB-approved, multicenter, prospective observational study was performed at three large teaching hospitals in the US. All adults who required a PICC for ⩾14 days were considered. Patients were monitored throughout entire catheter dwell. Duplex venous ultrasounds were performed before insertion, after 10 to 14 days of dwell time, and upon removal. Data was collected from the hospital, outpatient clinic, and patient PICC diary records. Results: A total of 103 patients, 56% male, with mean BMI 29 ± 8.8, were enrolled. The majority (79%) of patients were from high-risk groups—cancer, infectious diseases, transplant, and trauma. Primary treatment indications were antibiotics (66.99%) and chemotherapy (25.24%). Double lumen PICCs (59.2%) were favored clinically, as was basilic vein placement (71.84%). Mean catheter dwell was 47.01 ± 25.82 days. Three (3, 2.9%) central line-associated bloodstream infections (CLABSI) were reported. Four patients (4.6%) reported symptomatic catheter-related thrombosis (CRT), confirmed with ultrasound. Three patients (3.4%) had ultrasound-confirmed fibroblastic sleeve (FS). Eight patients (9.2%) who entered the study with pre-existing superficial thrombosis, had complete resolution at the time of catheter removal. The incidence of CLABSI was 0.82/1000 days. The combined CRT and FS rate was 6.9%. Conclusion: Based upon the observational findings of this study, chlorhexidine-coated PICC technology may be considered for use in patient populations who are at moderate to high-risk for catheter-related complications in both inpatient and outpatient settings.

Chlorhexidine digluconate exerts bactericidal activity vs Gram positive Staphylococci with bioelectrocatalytic compatibility: High level disinfection for implantable biofuel cells

“…for mouthwashes) [34,35] . Higher concentrations of 0.5% to 5% (and even up to 10 wt%) are employed for skin and surgical tool disinfection and for antibacterial coatings on medical devices [35][36][37][38]41] .…”

“…CHx is widely used in clinical settings for skin disinfection before and during surgery and injections, to sterilise surgical instruments and devices (e.g. catheters), across the field of dentistry from mouthwash to oral gel products to root canal irrigating solutions, and in various drug delivery devices [34,[36][37][38] .…”

“…CHx-impregnated devices in animals showed promising anti-infective activity; in one example, chlorhexidine was combined with silver sulfadiazine on Arrowgard Blue® central venous catheters [39,40] . In 2011, a CHx-coated catheter was cleared for human use [37] . Later, a CHxreleasing epoxy-based Ti orthoapedic implant displayed potent bactericidal activity against S. aureus and was well tolerated in vivo in mice, with no signs of toxicity by histological analysis despite high local concentrations of CHx (5 to 10 wt%) [41] .…”

Should ultrasound evaluation for catheter-related thrombosis always be required before PICC removal?

“…While many recent studies have given us reasonable figures about the incidence of symptomatic CRT in PICCs, 11,12,[17][18][19][20][21][22] the actual occurrence of asymptomatic CRT has been investigated only in few prospective studies. 11,12,23 Furthermore, in some of these prospective studies, the ultrasound finding of a FS (a very common pathophysiological phenomenon) is not mentioned, so it may be argued that the incidence of asymptomatic CRT might have been overestimated, due to a confusion between thrombus and sleeve.…”

“…11,12,23 Furthermore, in some of these prospective studies, the ultrasound finding of a FS (a very common pathophysiological phenomenon) is not mentioned, so it may be argued that the incidence of asymptomatic CRT might have been overestimated, due to a confusion between thrombus and sleeve. 17,24 This is largely due to the undisputed fact that FS is a very neglected complication of central venous access devices. 25 Though the morphologic differences between CRT and FS have been described in the literature, few clinicians are properly trained to discriminate one from the other at ultrasound scan.…”