Antithrombogenic peripherally inserted central catheters: overview of efficacy and safety

ABSTRACT

Introduction: Thrombotic complications associated with peripherally inserted central catheters (PICCs) are common, as most synthetic materials when placed in the presence of serum often result in platelet activation, fibrin deposition, thrombotic occlusion, and potentially embolization. A current innovation focus has been the development of antithrombogenic catheter materials, including hydrophilic and hydrophobic surfaces. These are being incorporated into PICCs in an attempt to prevent the normal thrombotic cascade leading to patient harm.

Areas covered: This review focuses on the laboratory efficacy and clinical effectiveness of antithrombogenic PICCs to prevent PICC-associated thrombosis, as well as their efficiency and safety. This synthesis was informed by a systematic identification of published and unpublished laboratory and clinical studies evaluating these technologies.

Expert commentary: A range of PICCs have been developed with antithrombogenic claims, using varying technologies. However, to date, there is no peer-reviewed laboratory research describing the individual PICCs’ effectiveness. Despite promising early clinical trials, adequately powered trials to establish efficacy, effectiveness, efficiency, and safety of all of the individual products have not yet been undertaken.

KEYWORDS:

• Central venous catheter thrombosis
• central venous catheters
• deep vein thrombosis
• peripheral venous catheterization
• upper extremity deep vein thrombosis
• venous thromboembolism

Contributors’ statement

Dr Ullman conceptualized and designed the study, drafted the initial manuscript, and approved the final manuscript as submitted. Drs Bulmer, Dargaville, Rickard, and Chopra contributed to the writing of the review and reviewed content prior to submission. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Declaration of interest

Griffith University has received investigator-initiated grants and unrestricted donations from vascular access product manufacturers (3M, Adhezion, Becton Dickinson, BBraun, Centurion Medical Products), to support research led by AJ Ullman, unrelated to the current project. Griffith University has received investigator-initiated grants to support research evaluating antithrombogenic PICC technologies led by AJ Ullman, by AngioDynamics Inc. AJ Ullman is supported by grants from the National Health and Medical Research Council (Australia). Griffith University has received investigator-initiated grants from vascular access product manufacturers (Becton Dickinson, Smiths Medical) to support research led by A Bulmer, unrelated to the current project. Griffith University has received investigator-initiated grants from vascular access product manufacturers (i.e., Becton Dickinson, Smiths Medical) to support research led by A Bulmer, unrelated to the current project. Griffith University has received unrestricted investigator-initiated research or educational grants on CM Rickard’s behalf from vascular access product manufacturers (3M, Adhezion, AngioDynamics Inc.; Bard; Baxter; BBraun; BD; Centurion Medical Products; Cook Medical; Entrotech; Flomedical; ICU Medical; Medical Australia; Medtronic; Smiths Medical; Teleflex). Griffith University has received consultancy payments on CM Rickard’s behalf from vascular access manufacturers (3M, Bard; BBraun, BD, ResQDevices, Smiths Medical). V Chopra is supported by grants from the Centers for Disease Control and the Agency for Healthcare Research and Quality. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.