Similar Device failure risk due to complications with peripherally inserted central catheter made of different materials: NEJM
In a new trial published in the New England Journal of Medicine it was revealed that hydrophobic or chlorhexidine peripherally inserted central catheters (PICCs) did not reduce the risk of device failure due to infectious or noninfectious complications compared to standard polyurethane PICCs in adults and children. These findings were concluded from a multicentre, randomized controlled superiority trial conducted in three Australian tertiary hospitals by Amanda J. and colleagues.
A multicenter, open-label, randomized trial of 1,098 patients of all ages were referred to the institutions during the study period for placement of PICCs. Patients were then randomized 1:1:1 to one of three PICCs: hydrophobic, chlorhexidine-coated, or standard polyurethane. The primary outcome was the rate of device failure, which was a composite of infectious (such as bloodstream or local infections) and noninfectious (such as thrombosis, catheter breakage, or occlusion) complications. Participants were followed up to 8 weeks after catheter placement.
Key Findings
Device Failure Rates:
Hydrophobic PICCs
• Device failure was seen in 21 of 358 participants, which translated to 5.9%.
Chlorhexidine PICCs
• Device failure was observed in 36 of 363 participants, equating to 9.9%.
• Standard Polyurethane PICCs: Device failure occurred in 22 of 359 participants (6.1%).
Risk differences were small between groups:
• Hydrophobic vs. standard polyurethane: −0.2 percentage points (95% CI, −3.7 to 3.2; p=0.89).
• Chlorhexidine vs. standard polyurethane: 3.8 percentage points (95% CI, −0.1 to 7.8; p=0.06).
Odds Ratios for Device Failure:
• Hydrophobic vs. standard polyurethane: OR 0.96 (95% CI, 0.51 to 1.78).
• Chlorhexidine vs. standard polyurethane: OR 1.71 (95% CI, 0.98 to 2.99).
Overall Complications:
• Hydrophobic PICCs: Complications occurred in 77 participants (21.5%).
• Chlorhexidine PICCs: Complications occurred in 140 participants (38.6%).
• Standard Polyurethane PICCs: Complications occurred in 78 participants (21.7%).
Odds ratios for overall complications:
• Hydrophobic vs. standard polyurethane: OR 0.99 (95% CI, 0.69 to 1.42).
• Chlorhexidine vs. standard polyurethane: OR 2.35 (95% CI, 1.68 to 3.29).
This trial concluded that hydrophobic and chlorhexidine-treated PICCs do not reduce the risk of device failure as compared to standard polyurethane PICCs in patients referred for catheter placement.
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