Publication Review: Do anti-microbial and anti-thrombogenic peripherally inserted central catheter (PICC) materials prevent catheter complications?

An analysis of 42,562 hospitalized medical patients

Original study by: A. Ullman et al. Infection Control & Hospital Epidemiology (2022), 43, 427–434

 Publication Review: Do antimicrobial and anti-thrombogenic peripherally inserted central catheter (PICC) materials prevent catheter complications? An analysis of 42,562 hospitalized medical patients – A. Ullman et al. Infection Control & Hospital Epidemiology (2022), 43, 427–434

 The article, published in 2022, discusses the use and complications of peripherally inserted central catheters (PICCs), which are increasingly used for administering various medical therapies due to their ease of insertion compared to traditional central venous catheters (CVCs).

 Despite their benefits, PICCs are associated with a high rate of complications, such as central-line–associated bloodstream infections (CLABSI), deep vein thrombosis (DVT), and occlusion, particularly in high-risk patient populations like those in intensive care units (ICUs) or oncology wards.

 To mitigate these complications, antimicrobial and anti-thrombogenic technologies have been incorporated into polyurethane PICC materials. However, the effectiveness of these innovations in reducing complications in the modern healthcare setting, where infection prevention practices have evolved, is unclear.

The article presents a study analyzing data from 42,562 hospitalized medical patients to compare the performance of coated antimicrobial PICCs, anti-thrombogenic polyurethane PICCs, and polyurethane PICCs in preventing CLABSI, venous thromboembolism (VTE), and occlusion in general and high-risk populations.

 The findings indicate that novel PICC anti-microbial coatings and materials were not associated with significant reductions in major complications. Antithrombogenic PICCs saw 21.5% all-cause complications, antimicrobial saw 38.6% and standard polyurethane saw 21.7%. The study suggests that while the theoretical benefits of PICC coatings and additives are promising, further research is needed to establish their clinical and economic effectiveness. The study also highlights the complex nature of PICC-related complications, suggesting that a multifaceted approach is required for prevention. It recommends cautious use of these newer polyurethane technologies until further evidence of their effectiveness is available, emphasizing the importance of optimizing other practices first, as per international guidelines.

Conclusion of publication review

Further Discussion

Given the findings that antimicrobial and antithrombogenic polyurethane materials may not significantly reduce catheter-related complications, there's a growing interest in exploring alternative technologies. One such alternative is an advanced consistently hydrophilic biomaterial called MIMIX™ - currently used for the HydroMID midline and HydroPICC single and dual lumen PICC catheters. This technology aims to minimize complications and the potential for thrombogenesis with its high-water concentration designed to avoid the foreign body response. Data from a retrospective study of 205 patients has already demonstrated a 6X reduction in catheter failures for HydroMID versus standard polyurethane (Bunch, J., J of Infusion Nursing 2022) and a 99.99% reduction in bacterial adhesion based on an in vitro blood loop model (Leroy, AVA, 2023).*

The introduction of these alternatives underscores the importance of continuous innovation in the field of vascular access. As the healthcare community seeks to improve patient outcomes and reduce the incidence of catheter-related complications, the exploration of new materials and technologies like HydroMID and HydroPICC becomes increasingly vital. Future studies should focus on comparing these innovative solutions with traditional and coated PICCs to establish their efficacy in various patient populations. Only through clinical adoption and evaluation can the true benefits of these advanced materials be fully realized, potentially leading to a paradigm shift in the management and prevention of catheter-related complications.

 *Pre-clinical in vitro valuations do not necessarily predict clinical performance with respect to thrombus formation.

 By AVI Clinical Team