Vascular Access Complications 101 – Causes, Impact, and Potential Solutions to Reduce Common Catheter Complications
By Maya Yearns, RN, VA-BC
Vascular access is a critical component of healthcare with vascular access device (VAD) use essential in healthcare settings around the world. Commonly used VAD catheters include peripheral devices such as peripheral intravenous catheters (IVs) and midlines, and central venous access devices such as peripherally inserted central catheters (PICCs) and centrally inserted central catheters (CICCs). While VADs are inserted to allow medications, fluids, and blood to be administered to patients to optimize their health, they also have known risks and the potential to heighten patient anxiety. Decreasing complications associated with VAD devices can both improve outcomes and increase patient trust.
Patients undergoing healthcare procedures have many reasons to be anxious; negative outcomes, devastating diagnoses, and loss of privacy and control contribute to this anxiety. Among these major fears one might not think of needles as significant; however, a global survey of over 2,000 adults found that 62.3% reported a fear of needles and over 50% avoided routine healthcare, such as blood draw due to this fear. This same survey reported that frequent exposure to the healthcare system and previous negative experiences with needles contributed to the development of needle phobia (1). For a patient with a fear of needles, the placement of a VAD can be an extremely traumatic facet of healthcare; for that device to then develop a complication, not work as promised, and potentially cause more pain can reinforce their fear and lead to distrust of medical staff.
The most common complications associated with vascular access catheters are thrombosis and infection (2). Thrombosis, a blood clot that impedes normal blood flow, can form in the vein surrounding the catheter or within the lumen of the catheter itself. Thrombus formation is the natural outcome of vein trauma and decreased blood flow and attempts to decrease trauma and ensure adequate blood flow have helped decrease thrombosis formation; however, the estimated incidence of catheter associated thrombosis is 14-18% (3). These thrombotic events can delay patient care, increase costs, require replacement of the device, and even lead to patient harm through events such as deep vein thrombosis (DVT) and infiltration (3,4).
Thrombosis is aided by the body’s recognition of a vascular access device as foreign and its attempt to protect itself by creating a barrier of plasma proteins, platelets, and fibrin around the foreign material. These cells are attracted to the sticky and hydrophobic polyurethane material of which most VADs are composed. This hydrophobic material repels water leading the body to instantly recognize it as a foreign material. The buildup of cells on the internal and external lumen of a VAD can attract bacteria, giving them an environment in which to multiply and grow a bacterial biofilm, and eventually lead to catheter-related blood stream infection (CRBSI) or central line-associated blood stream infection (CLABSI) (5,6).
The vascular access complications of CRBSI and CLABSI can prolong hospital stay, increase costs, and are associated with significant mortality. Many healthcare facilities have attempted to decrease CRBSI and CLABSI rates through insertion and care and maintenance bundles (4), and
some have made great strides in reducing their numbers of hospital onset blood stream infections (HOBSI). Unfortunately, CLABSI numbers remain high at many facilities (7). One novel approach to reducing complications in vascular access devices is the use of the hydrophilic biomaterial catheters made by Access Vascular, Inc. The HydroMID® and HydroPICC® catheters are composed of MIMIXTM material that attracts water to the internal and external surface of the catheter lumen camouflaging the device; this disguise does not activate the foreign body response. This material has been proven to decrease complications such as thrombosis and infection and increase patency and dwell time. An in vitro study of catheters composed of the MIMIXTM material demonstrated a 99.99% decrease in bacterial adhesion as compared to traditional polyurethane catheters and a 96% reduction in thrombus accumulation on the catheter (8). A retrospective study of over 200 patients who had undergone midline placement demonstrated a 6 times higher failure rate with traditional polyurethane catheters as compared to the HydroMID® catheters made by Access Vascular, Inc (9). Vascular access device placement is both necessary for healthcare delivery and traumatic for many patients. While some complications in healthcare cannot be avoided, in vascular access, the utilization of hydrophilic biomaterial catheters have demonstrated a decrease in complications. The ability to place a VAD that will allow completion of the required therapy without complications and decrease the overall number of needle sticks in all patients will improve outcomes, decrease costs, and increase patient satisfaction and trust.
References
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Wan R, Gu L, Yin B, Cai S, Zhou R, Yang W. (2023). A six-year study of complications relatedto peripherally inserted central catheters: A multi-center retrospective cohort study inChina. Perfusion, 38(4):689-697. doi:10.1177/02676591221076287
Wall, C., Moore, J., & Thachil, J. (2016). Catheter-related thrombosis: a practicalapproach. Journal of the Intensive Care Society, 17(2), 160-167
Gorski, L. A., Hadaway, L., Hagle, M. E., Broadhurst, D., Clare, S., Kleidon, T., Meyer, B. M.,Nickel, B., Rowley, S., Sharpe, E., & Alexander, M. (2021). Infusion therapy standards ofpractice, 8th edition. Journal of Infusion Nursing, 44(1S).https://doi.org/10.1097/nan.0000000000000396
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Centers for Disease Control and Prevention. Checklist for Central Line AssociatedBloodstream Infections. https://www.cdc.gov/hai/pdfs/bsi/checklist-for-CLABSI.pdf.Accessed 10 Feb 2024
Lastinger, L. M., Alvarez, C. R., Kofman, A., Konnor, R. Y., Kuhar, D. T., Nkwata, A., … Dudeck,M.A. (2023). Continued increases in the incidence of healthcare-associated infection (HAI) during the second year of the coronavirus disease 2019 (COVID-19) pandemic. Infection Control & Hospital Epidemiology, 44(6), 997–1001. doi:10.1017/ice.2022.116 8.
LeRoy, K. J., & Donahue, D. T. (2023). Results of A Bench Model Investigating Bacterial Adhesion on Novel Hydrophilic Biomaterial Catheter. Presented at AVA 2023 via e-poster.
Bunch J. A retrospective assessment of peripheral midline failures focusing on catheter composition. J Infus Nurs. Sept/Oct 2022; 45(5):270-27
