Novel short peripheral catheter design for prevention of thrombophlebitis

Abstract

Phlebitis is one of the most frequent complications related to short peripheral catheters (SPC). A new SPC design, aimed for minimizing mechanical phlebitis, was tested in vivo in swine. MRI analysis revealed 40% less inflammation with the new SPC design compared to commercial SPC. The results confirm that our SPC biomechanical design approach can minimize phlebitis rates. Summary BackgroundShort peripheral catheters (SPCs) are the most common intravenous device in today's medical practice. Short peripheral catheter thrombophlebitis (SPCT) occurs in up to 80% of hospitalized patients. Symptoms appear on average 3 days after catheter insertion and can lead to extended hospitalization and increased related costs. Here we introduce a novel SPC, named very short peripheral catheter (VSPC), that was designed to minimize biomechanical irritation and improve blood flow. ObjectiveThe goal was to test the performance of the novel catheter in vivo for reduction of thrombophlebitis. MethodsVery short peripheral catheter prototypes were inserted into swine ear veins (n = 12). Verification of the catheter conformation in situ and blood perfusion was performed using Echo‐Doppler. The SPCT development rate was measured using magnetic resonance imaging (MRI), 4 and 12 days after catheter insertion, and analyzed by means of edema and inflammation intensities. Blind histopathology analysis was performed on the veins postmortem. Clinically available SPC was used as a reference. ResultsOperation of the VSPC devices did not require any special skills over those used for the clinically available SPC. Echo‐Doppler imaging confirmed that in contrast to the traditional SPC, the VSPC avoided contact with the vein wall and allowed better blood perfusion. The MRI analysis revealed 2‐fold inflammation and edema rates (~80%) in the veins cannulated with the commercial SPC, whereas rates of only ~40% were seen with the novel VSPC. A similar trend was noticed in the histopathology analysis. ConclusionsThe results indicate that the novel catheter design significantly reduced SPCT rates and demonstrated proof of concept for our biomechanical approach.

Identifying Predictors of Peripheral Intravenous Catheter Failure Using a Novel Combination of Clinical and Ultrasonographic Assessments

“…14 Another study in an animal model found that modi cation of the catheter with the goal of reducing contact against the vein wall led to a 40% reduction in subcutaneous edema. 18 In our study, not only did we identify that subcutaneous edema existed in the majority of our insertions, but we also found that subcutaneous edema on ultrasound was a signi cant predictor of PIVC failure, a key clinical outcome measure. However, unlike previous investigations, we tracked onset and progression of subcutaneous changes using an innovative methodology inclusive of daily ultrasound site assessments.…”

Design, development, and preliminary assessment of a novel peripheral intravenous catheter aimed at reducing early failure rates

“…We followed the histopathological methods reported in a previous study investigating a novel PIVC design. Weiss et al (19) also inserted 20 G BD Insyte PIVCs into the veins of porcine ears, however their study lasted 12 days, compared to our 2-day study, with typical clinical practice indicating PIVC usage for short-term administration of fluids and medication (2-3 days) in critical conditions requiring mechanical ventilation and critical care management.…”

“…All physical prototyping was performed at a specialised catheter manufacturing facility (Medical Murray, IL, USA). Similar to a previous study (19), we decided to modify a commercial device to allow a true comparison of the FloRamp with an existing PIVC. We chose the 20 G BD Insyte™ winged 45 mm long catheter (Becton Dickenson, Franklin Lakes, NJ, USA), as the BD Insyte is widely used and familiar to most infusion therapists.…”

Early recognition of peripheral intravenous catheter failure using serial ultrasonographic assessments

“…Recent exploratory literature has suggested that subcutaneous edema represents more than a compromised or leaking vein due to infiltration. Instead, subcutaneous edema may represent a local inflammatory reaction due to ongoing mechanical and chemical insults to the vein wall [ 10 , 13 , 14 ]. Strategies targeting a reduction of subcutaneous edema may improve PIVC survival.…”

“…In an analysis on the location of catheter tip position within the vein, Murayama et al found that contact of the tip against the vein wall was associated with subcutaneous edema on ultrasound [ 10 ]. Another study in an animal model found that modifying the catheter within the vein to reduce contact against the vein wall led to a 40% reduction in subcutaneous edema [ 14 ]. Our data and these findings suggest that modification of the PIVC tip position is likely another key component in reducing early catheter failure.…”