A Retrospective Assessment of Midline Catheter Failures Focusing on Catheter Composition

Infiltration and Extravasation Risk with Midline Catheters: A Narrative Literature Review

Midline catheters have recently gained popularity in clinical use, with a common reason being the reduction of central venous catheter use and central line-associated bloodstream infections. At the same time, the number of nononcology vesicant medications has increased, and midline catheters are frequently being used for infusions of vesicant medications. The Infusion Nurses Society (INS) Vesicant Task Force identified midline catheter use as a possible risk factor for extravasation and concluded that a thorough literature review was necessary. This review highlights the variations in catheter terminology and tip locations, the frequency of infiltration and extravasation in published studies, and case reports of infiltration and extravasation from midline catheters. It also examines the many clinical issues requiring evidence-based decision-making for the most appropriate type of vascular access devices. After more than 30 years of clinical practice with midline catheters and what appears to be a significant number of studies, evidence is still insufficient to answer questions about infusion of vesicant and irritant medications through midline catheters. Given the absence of consensus on tip location, inadequate evidence of clinical outcomes, and importance of patient safety, the continuous infusion of vesicants, all parenteral nutrition formulas, and infusates with extremes in pH and osmolarity should be avoided through midline catheters.

Hydrophilic biomaterial intravenous hydrogel catheter for complication reduction in PICC and midline catheters

INTRODUCTION

More than 30% of peripherally inserted central catheters (PICCs) and midline catheters experience complications. Most complications are related to thrombotic cellular adherence to catheter materials.

AREAS COVERED

This manuscript outlines PICC and midline catheter complications, the need to reduce complications and how hydrogel catheters may provide a solution to address these unmet needs based on available evidence.

EXPERT OPINION

Patients commonly require PICC or midline catheters for treatment to establish a reliable form of intravenous access. Catheters, while reliable in most cases, are not without complications, including occlusion, thrombosis and infection, each related to cellular adherence to the catheter material. Hydrophilic catheter coatings and composites have been developed to mitigate these thrombotic complications, reduce adherence of blood and bacterial cells to catheters and provide greater patient safety with these devices. Hydrogel materials are highly biocompatible and have been effective in reducing cellular adherence and the formation of biofilms on surfaces. Smooth hydrophilic catheter surfaces are potentially more comfortable for the patient, with reduced friction during insertion and removal. A catheter constructed of hydrophilic biomaterial, a hydrogel composite material, may minimize thrombotic complications in PICC and midline catheters, improving catheter performance and outcomes for patients.

A retrospective, comparative, clinical study of occlusion rate of peripherally inserted central catheters fabricated of poly(vinyl alcohol)-based hydrogel composite

Thrombotic accumulation is associated with surface interactions between blood proteins and vascular access devices. Catheter occlusion results from this process, and is a costly, common, occurrence with peripherally inserted central catheters (PICCs). Hydrophilic catheter materials exhibit antithrombotic properties. This retrospective study evaluates the occurrence of catheter occlusion of PICCs constructed of a poly(vinyl alcohol)-based hydrogel composite known as hydrophilic biomaterial (HBM), compared to thermoplastic polyurethane (TPU) control devices. A total of 121 PICCs, 60 HBM and 61 TPU, were placed in patients with a clinical need and were reviewed for the occurrence of catheter occlusion. The records review found that occlusions occurred in 0/60 (0.0%) of the HBM PICCs and 13/61 (21.3%) of TPU PICCs (p = 0.001). HBM exhibits favorable qualities for vascular access, most importantly its extreme hydrophilicity. Clinically, this may be responsible for the reduction in PICC occlusions, which could improve patient outcomes.

Trackability of a high-strength thromboresistant hydrogel catheter: An In vitro analysis comparing venous catheter forces in a simulated use pathway

As the need for vascular access devices (VADs) continues to increase, so does the need for innovative designs and materials that can improve placement and optimize patient outcomes. Commercially available peripherally inserted central venous catheters (PICCs) are in high demand due to their ease of use and low cost. However, they are constructed of materials that can contribute to vascular injury and result in complications such as clotting, catheter failure, and infection. This study investigated the surface and frictional properties of a HydroPICC® device constructed of a novel, inherently lubricious bulk hydrogel. Investigators posited that these materials would lower the forces required to advance and retract the HydroPICC® devices and that the measured forces are significantly lower than those of two commercially available PICCs made of conventional thermoplastic polyurethane. The HydroPICC® device had a lower insertion and retraction force compared to both the PowerPICC^TM and BioFlo^TM control devices based on an unpaired, two-sided t-test (P < .001). The HydroPICC® also exhibited a statistically significant decrease in average force when compared to both conventional PICCs (P < .001 and P = .001). When compared to PowerPICC^TM, the lubricious high-strength HydroPICC® hydrogel device exhibited an 84% ± 25% reduction in average tracking force; additionally, when compared to a fluoro-oligomer modified TPU catheter (BioFlo^TM), the HydroPICC® device exhibited a 90 ± 32% reduction in average tracking force. The HydroPICC® technology represents a new method to reduce frictional forces of implantable devices. Clinical trials are needed to determine whether the differences in frictional properties between conventional VADs and HydroPICC® devices translate into improved clinical outcomes.