Do antimicrobial and antithrombogenic peripherally inserted central catheter (PICC) materials prevent catheter complications? An analysis of 42,562 hospitalized medical patients

Abstract

Objective: To examine the effectiveness of antimicrobial and antithrombogenic materials incorporated into peripherally inserted central catheters (PICCs) to prevent bloodstream infection, thrombosis, and catheter occlusion. Methods: Prospective cohort study involving 52 hospitals participating in the Michigan Hospital Medicine Safety Consortium. Sample included adult hospitalized medical patients who received a PICC between January 2013 and October 2019. Coated and impregnated catheters were identified by name, brand, and device marketing or regulatory materials. Multivariable Cox proportional hazards models with robust sandwich standard error estimates accounting for the clustered nature of data were used to identify factors associated with PICC complications in coated versus noncoated devices across general care, intensive care unit (ICU), and oncology patients. Results were expressed as hazard ratios (HRs) with corresponding 95% confidence intervals (CIs). Results: Of 42,562 patients with a PICC, 39,806 (93.5%) were plain polyurethane, 2,263 (5.3%) incorporated antimicrobial materials, and 921 (2.2%) incorporated antithrombogenic materials. Most were inserted in general ward settings (n = 28,111, 66.0%), with 12, 078 (28.4%) and 1,407 (3.3%) placed in ICU and oncological settings, respectively. Within the entire cohort, 540 (1.3%) developed thrombosis, 745 (1.8%) developed bloodstream infection, and 4,090 (9.6%) developed catheter occlusion. Adjusting for known risk factors, antimicrobial PICCs were not associated with infection reduction (HR, 1.16; 95% CI, 0.82–1.64), and antithrombogenic PICCs were not associated with reduction in thrombosis and occlusion (HR, 1.15; 95% CI, 0.92–1.44). Results were consistent across populations and care settings. Conclusions: Antimicrobial and antithrombogenic PICCs were not associated with a reduction in major catheter complications. Guidance aimed at informing use of these devices, balancing benefits against cost, appear necessary.

Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 Update

“…Some evidence suggests that use of antimicrobial CVCs, along with other preventive technologies, may have no additional benefit in patient care units that have already established a low incidence of catheter infections. 174,175 ii. Patients have limited venous access and a history of recurrent CLABSI.…”

Application of Nursing Intervention Based on Intelligent Grip Strength System in Patients with Tumor PICC: A Case-Control Study on Promoting Functional Exercise and Quality of Life

“…Tumor research groups in Germany and the UK employed conventional doses of low molecular weight heparin and warfarin to prevent thrombosis, respectively, but did not achieve the desired results [9]. In addition, meta-analysis of 12 randomized controlled trials in the Cochrane database indicated that 3611 patients with catheterization using preventive dose heparin or low-dose vitamin K antagonists also failed to confirm the effect of anticoagulants in reducing the incidence of thrombosis [10].…”

Integrative Review: Complications of Peripherally Inserted Central Catheters (PICC) and Midline Catheters with Economic Analysis of Potential Impact of Hydrophilic Catheter Material

“…Considering the characteristics of ideal catheter and material components identified in the literature, high biocompatibility, resistance to protein adsorption, chemical resistance, pliability with high tensile strength, smooth surface with anti-adhesive properties, and durability with long-term dwell and maintenance of flow were the chief points [53,55,58,73]. The published studies included in the materials review varied greatly and served to inform rather than provide a means of clear evaluation of effectiveness for any one brand or type of catheter, except for the frequent mention of hydrophilic catheter and lubricity characteristics in the coated HydroCath, and composite HydroPICC and HydroMID (Access Vascular, Inc, Billerica, MA, USA) [6,54,62,74].…”

“…In a 30-month comparator study of antimicrobial and nonantimicrobial PICCs by DeVries et al achieved a significant reduction in PABSI with an initial rate of infection at 1.83 versus 0.62/1000 cd [52]. In another large prospective cohort study in 52 hospitals the analysis of 42,562 patients the investigators found no reduction in thrombosis, infection, or occlusion with either antimicrobial or antithrombotic PICCs [74]. In a systematic review of PICCs and central venous catheters, Slaughter et al concluded that differences of catheter material or design did not have a significant effect on incidence of thrombosis, infection, or occlusion [69].…”