Avoiding Thrombosis with Vascular Access: The Role of Improved Catheter Materials
By: Nancy Moureau, PhD, RN, CRNI, CPUI, VA-BC — PICC Excellence, Inc.
Vascular access devices (VADs) such as peripherally inserted central catheters (PICCs) and Midline catheters are integral to modern healthcare, providing essential access for treatments, infusions, and medications. Yet, despite their critical role, VADs are not without risk. More than 30% of patients with VADs experience complications, ranging from catheter failure and occlusion to catheter-related thrombosis (CRT), bloodstream infections (CRBSI), and, tragically, even death. Millions of these complications occur annually, placing immense physical, emotional, and economic burdens on patients and healthcare systems.[1]
This reality demands a renewed focus on strategies to prevent complications, with thrombosis and occlusion remaining among the most significant concerns. Thrombosis, which can occur when blood components adhere to the catheter surface and trigger clot formation, disrupts functionality and increases the risk of infection, catheter replacement, and hospital readmissions. A growing body of evidence suggests that improvements in catheter materials could be a game-changer, offering enhanced biocompatibility and reduced thrombogenicity, thereby mitigating these complications. [2]
Complication Incidence and Benchmarking Outcomes
A comprehensive integrative review has established clear benchmarks for PICC and Midline catheter complication rates.[3] Catheter-related thrombosis remains a major issue, studies estimating up to 15% of PICCs lead to thrombotic events, particularly in patients with prolonged dwell times or underlying comorbidities.[4] Catheter occlusions, often stemming from platelet and fibrin accumulation, occur at even higher rates, impacting up to 30% of devices. Similarly, catheter-associated bloodstream infections frequently following thrombus formation add further complexity and risk [5]. These complications not only compromise patient safety but also shorten catheter dwell times and lead to avoidable costs for healthcare systems.
Advances in Catheter Material Technology
Over the past three decades, catheter technology has advanced significantly, with materials evolving from silicone and standard polyurethane to more sophisticated coatings and impregnations designed to improve performance. Most modern PICCs and Midlines are composed of polyurethane, a material chosen for its flexibility and durability. However, even polyurethane has limitations, as its surface promotes protein and blood cell adherence, creating conditions favorable for thrombosis and infection. [5], [6]
In response, a new generation of catheter materials has emerged, including a hydrogel-based hydrophilic composition. This innovative material, constructed from porous radiopaque polyvinyl alcohol (PVA) and heat-treated for cross-linked strength, represents a significant leap forward. The hydrogel material is highly biocompatible and hydrophilic, meaning it interacts more effectively with bodily fluids and is far less prone to the foreign body responses that lead to cellular adhesion.[3]
How Hydrogel Catheters Outperform Polyurethane
The properties of the hydrogel composite are particularly promising when compared to standard polyurethane catheters. In laboratory studies, hydrogel catheters demonstrated an impressive 97% reduction in platelet adhesion and thrombus accumulation on their surface during blood loop testing. [2] This hydrophilic material absorbs water readily, creating a super-lubricious surface that minimizes friction between the catheter and surrounding blood components.
From a clinical perspective, this reduced blood cell and protein adherence translates to a significantly lower likelihood of thrombosis and occlusion. By minimizing clot formation, hydrogel materials also reduce the risk of catheter-associated bloodstream infections, as thrombi can serve as a breeding ground for bacteria. [2]
Economic and Clinical Impact
The implications of these material advancements extend beyond patient safety to healthcare economics. Each catheter complication comes at a cost—financially and operationally. Thrombosis and occlusion often necessitate catheter replacement, prolonged hospital stays, or additional treatments such as thrombolytic therapy. [5] Catheter-related infections, in particular, are associated with skyrocketing costs due to extended hospitalization and increased morbidity.
Hydrogel catheters offer the potential for substantial cost savings by reducing complication rates. For example, a hospital system that reduces catheter failure rates by even a small margin could realize significant savings in supply costs and staff time, not to mention the avoidance of downstream expenses related to infection treatment and patient readmissions. [2]
A cost-benefit analysis of hydrogel catheters has shown that the upfront investment in advanced materials is offset by the reduction in complications and improved device performance. [2] Longer dwell times, fewer replacements, and greater reliability contribute to better outcomes for patients and providers.
Implementation and Future Directions
Thrombosis occurs when blood components, such as platelets and fibrin, adhere to the catheter surface, triggering clot formation. These clots can obstruct blood flow, increase infection risk, and cause pain and swelling, leading to early device failure and potentially life-threatening consequences such as pulmonary embolism. Specifically, research must focus on the material's ability to prevent catheter-related thrombosis (CRT), one of the most prevalent and dangerous complications.
Preventing thrombosis requires a multi-faceted approach that includes advanced catheter material selection, proper insertion techniques, and ongoing catheter care. Hydrogel-based materials are designed to reduce platelet adhesion and thrombus formation by creating a hydrophilic, lubricious surface that discourages cellular interaction. Combined with other thrombosis prevention measures—such as maintaining catheter patency through regular flushing protocols, avoiding catheter placement in areas of high blood flow turbulence, and minimizing catheter dwell times where possible—these materials offer a promising solution for more effective vascular access. [5]
For clinicians, these advances highlight the importance of evidence-based device selection. The decision to use a particular catheter material should not be based solely on availability or cost but must incorporate data on material performance, complication incidence, and overall economic impact. Catheter-related thrombosis can be avoided through adherence to insertion and maintenance guidelines, such as those outlined in evidence-based best practices. These include ultrasound guidance to reduce inadvertent vessel trauma, appropriate catheter sizing to minimize vein-wall irritation, and limiting unnecessary catheter manipulations. When combined with hydrogel materials, which reduce the catheter's thrombogenic potential, clinicians can significantly decrease the likelihood of clot formation.
Furthermore, a comprehensive approach to vascular access management—combining advanced catheter materials with standardized insertion techniques, competency-based training, and diligent maintenance practices—will be critical to reducing complications. Evidence shows that proper education and competency assessments for vascular access procedures are crucial for achieving high success rates and minimizing complications like thrombosis. Simulation-based training and mastery learning programs, for example, can help ensure clinicians are skilled in selecting the correct catheter size, minimizing insertion-related vessel trauma, and ensuring optimal catheter positioning.
Healthcare organizations must also provide education and resources to support clinicians in effectively adopting new technologies. This includes training using advanced catheter materials and implementing strict protocols for catheter flushing, securing, and monitoring for early signs of thrombosis, such as swelling, and pain. Establishing multidisciplinary vascular access teams can further drive improvements in practice, as these teams are often well-positioned to evaluate emerging technologies, oversee evidence-based protocols, and monitor catheter-related complications.
Conclusion
The evolution of catheter materials represents a major opportunity to improve patient outcomes and reduce complications associated with vascular access devices. Catheter-related thrombosis remains one of the most significant challenges in vascular access care, compromising catheter function, increasing patient discomfort, and contributing to serious health risks. However, the development of hydrogel-based, hydrophilic catheter technology offers a promising solution by enhancing biocompatibility, reducing thrombogenicity, and minimizing platelet adhesion—key factors in preventing thrombus formation.
As evidence continues to grow, clinicians and healthcare leaders must prioritize these advancements, recognizing their profound impact on patient safety, satisfaction, and healthcare costs. Integrating hydrogel technology into clinical practice, alongside adherence to standardized insertion techniques, thrombosis prevention strategies, and ongoing education, offers the potential to revolutionize vascular access care. By focusing on the entire continuum of catheter management—material selection, placement, maintenance, and monitoring—healthcare systems can reduce the incidence of thrombosis and other complications, extend catheter dwell times, and improve patient outcomes.
Ultimately, avoiding thrombosis requires a collaborative, evidence-based approach combining innovative catheter technology with best care practices. By leveraging advanced hydrogel materials and investing in clinician education and competency, we can move closer to achieving optimal outcomes for every patient requiring vascular access, reducing complications, and improving the overall patient experience.
References
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Mannarino MM, Bassett M, Donahue DT, Biggins JF. Novel high-strength thromboresistant poly (vinyl alcohol)-based hydrogel for vascular access applications. Journal of Biomaterials Science, Polymer Edition. 2020 Mar 23;31(5):601-21.
Moureau NL, McKneally E, Hofbeck D. Integrative review: complications of peripherally inserted central catheters (PICC) and midline catheters with economic analysis of potential impact of hydrophilic catheter material. Int J Nurs Health Care Res. 2022;5(10):17.
Moureau N. Hydrophilic biomaterial intravenous hydrogel catheter for complication reduction in PICC and midline catheters. Expert Review of Medical Devices. 2024 Mar 3;21(3):207-16.
Schults JA, Kleidon T, Charles K, Young ER, Ullman AJ. Peripherally inserted central catheter design and material for reducing catheter failure and complications. Cochrane Database of Systematic Reviews. 2024(6).
Seckold T, Walker S, Dwyer T. A comparison of silicone and polyurethane PICC lines and postinsertion complication rates: a systematic review. The journal of vascular access. 2015 May;16(3):167-77.