Q&A with 1st HydroPICC User

The very first clinical user of HydroPICC has used it in 50 cases, with no occlusions to date. We thought it would be interesting for him to share his experience with other vascular access specialists, for whom HydroPICC could be beneficial. Many thanks to Joseph Bunch, RN, Principal Owner of Provasc, Ltd., a leading PICC placement firm in Chicagoland, Illinois, for sharing his perspective.

 Tell us about your PICC placement service.

I own a vascular access company out in the Chicagoland area. We place central venous access devices out of hospitals and skilled nursing facilities.

 Tell us about the problem of thrombus development related to PICCs.

The problem in general with a thrombus within a catheter is it is occurring all too often. There's nothing more frustrating than placing a line and, in three days, you're going back to de-clot it. On a daily basis, we see lines occluding and patients developing DVTs. 30% of all lines that are placed have some type of catheter-related issue. There are approximately 35% to 72% of asymptomatic cases of venous thrombosis with every PICC line that is placed.

 This frustrates me because an occluded line can delay a patient’s treatment and medications that they critically need. If they're on vasoactive medicine, ultimately, it could have a direct effect on their immediate health because they're not able to maintain blood pressure. They may not get their continuous infusion of nutrition. You may have to switch out the line. You may have to give an antithrombotic agent in order to open the line back up.

 I take full responsibility for lines that I place, and I am not a big fan of these catheters that are out there. I don't think it's right that I should be placing a PICC line and, a week later, coming back to a blood clot on it. There's something wrong here. We can do better.

 What do you experience with PICC-related thrombus? 

Thrombus can be asymptomatic or symptomatic, dependent on whether the thrombus is around the catheter or within the vein itself, so the presentation can be different. With symptomatic patients, the vein can be completely occluded, which may mean a swollen, red arm and could lead to infection or pulmonary embolism. That would be a worst case scenario.

 If it's intraluminal, we would know because the infusion would become sluggish. At the bedside, you're supposed to do an aspiration first to make sure there's adequate blood flow, that you have a good blood return, and then you know your catheter is functioning properly. But if it is sluggish or you're getting no blood return whatsoever, you should suspect that there is a thrombus.

 We have noticed that COVID-19 patients tend to clot faster. In normal circumstances, if you're using a power-rated catheter in a critically ill patient, you tend to see clotting within a week or two; with COVID patients, we’re seeing lines clotting within 24 hours.

 Does the type of PICC you use make a difference when it comes to thrombus development?

Thrombus accumulation definitely has a factor with the type of catheter that's being used. I've seen this in my experience on a number of occasions. Some patients just can't tolerate a stiff catheter. A lot of the power-rated catheters that are out there are very stiff and rigid, and this tends to cause endothelial damage or endothelial irritation, which starts that cascade of swelling. Mostly, you'll see the patient develop a level of phlebitis. This would be considered a mechanical phlebitis and we see this a lot of times with patients that have rigid catheters within their veins.

 You have used HydroPICC in quite a few cases to date – tell us about your experience.

My experience has been great. With HydroPICC, we've yet to see a case that developed a thrombus, a total lumen occlusion or a complication, such as phlebitis. When using some of the other catheters, sometimes within about a week or two, we're called back to de-clot a line that has been thrombosed.

InVitro Blood Loop Results*

Tested for 12 minutes using FDA-recognized blood flow loop test conducted by Thrombodyne Inc.

*No correlation between in vitro/in vivo testing methods and clinical outcomes have currently been ascertained.

A good example is a long-time patient of mine who has a history of difficult venous access. We had previously placed polyurethane PICCs in her that needed to be declotted after four days. When we placed a HydroPICC, it lasted without incident for about 35 days, and it likely would have gone longer but another clinic she frequented swapped catheters as a matter of course, and not because of clotting.

 Comparing HydroPICC to some of the other lines that we do place, there's a relative ease with insertion. The single lumen catheter is a little bit lightweight and it makes placement a lot easier than some other PICC lines that I’ve used. It tends to go right where it's supposed to go. It follows the natural path of blood flow. Some of the others, depending on how you place the patient's arm, they want to go straight up north rather than south where it needs to be.

 What are the benefits of HydroPICC that you have observed?

I definitely see how HydroPICC could impact patient results. The patients that I have seen are benefiting from the catheter itself. I've seen what happens when a HydroPICC is placed inside a patient. I see that there are fewer complications. So, my plans moving forward in using HydroPICC are to place them in every single patient we come across.

Final thoughts?

The problem with our industry is we've been stuck in a certain realm of what catheters to use - there hasn't really been much of a variance out there. Seeing that there is now a product that is lighter weight yet can withstand the power-rated infusions, and is much less likely to cause a thrombosis, this is something that I want to use and this is something that I want for my patients.