A study published in the Fall 2014 issue of the Journal of the Association for Vascular Access (JAVA) showed that a chlorhexidine-impregnated peripherally inserted central catheter (PICC) eliminated central line-associated bloodstream infections (CLABSIs) during the two-year study period (July 2011-July 2013). In addition, only one incidence of thrombosis occurred during the study period – a non-occlusive thrombus associated with device insertion. When the study ended, the good results continued: No CLABSIs or episodes of thrombosis were associated with the catheter between the end of the study and the study’s publication.
Put another way, the study found that the PICC (ARROW PICC with Chlorag+ardÒ Technology) did exactly what it was designed to do. The chlorhexidine bonded into the catheter’s internal and external surfaces is intended to be both antimicrobial and antithrombogenic – which means it fights infections and thrombosis simultaneously. Use of the PICC was the only new intervention in the study, so the results are entirely attributable to the device. (Disclosure: Teleflex, Inc., the maker of the PICC is a Dowling & Dennis client.)
The study took place at Good Shepherd Specialty Hospital (GSSH) in Bethlehem, Penn. Good Shepherd was motivated to try the PICC because of changes in Medicare reimbursement that went into effect in January 2011. The Medicare changes were aimed at incentivizing the nation’s hospitals to reduce CLABSIs, and poor performers stood to lose a slice of their Medicare reimbursements.
The fact that a single device can reduce both infections and thrombosis is important. Since the early 2000s, a national campaign waged by the federal and state governments along with many private organizations has focused on minimizing central line-associated bloodstream infections (CLABSIs). That’s a worthy effort because CLABSIs are one of the most dangerous varieties of healthcare-acquired conditions (HACs) – that is, conditions that patients suffer at a healthcare facility, as opposed to conditions they arrive with. CLABSIs can be fatal in up to 25% of non-cancer patients and up to 36% of patients who do have cancer.
But all the attention on CLABSIs has somewhat distracted the public from the dangers of thrombosis, another complication of IV therapy. Thrombosis — a clot in a blood vessel that obstructs blood flow — can lead to a CLABSI, because the clots contain the fibrin upon which bloodstream-infecting bacteria feed. Thrombosis can also result in other serious conditions such as deep vein thrombosis (DVT), post-thrombotic syndrome, and pulmonary embolism. Together, these conditions can have consequences that range from impaired quality-of-life to death.
The ARROW PICC is the world’s first PICC to be both antimicrobial and antithrombogenic. The federal Centers for Disease Control and Epidemiology (CDC), the Society for Health Epidemiology of America (SHEA), and the Infusion Nurses Society (INS) recommend antimicrobial catheters for certain situations which normally include:
- An expectation that the catheter will dwell for more than five days.
- A hospital’s failure to reduce a high CLABSI rate even after implementing a comprehensive strategy to prevent the infections.
Perhaps we’ll see such recommendations expand to include high thrombosis rates in the future. In the meantime, the JAVA study shows that a single device can be effective against CLABSIs and thrombosis at the same time.