On point: Trends and developments in vascular access devices and antimicrobials
Rubber and plastic manufacturer Cikautxo Medical outlines the latest developments in vascular access devices and antimicrobial trends.
The European Vascular Access Catheter market has been affected in the last years by some main trends, one of them related to the alternatives that the PICC and midline catheters offer as a substitution to conventional CVC catheters and other one related to the increasing use of antimicrobial and anti-thrombogenic performances on the catheters to reduce risks of infections and thrombus in patients.
Vascular access catheter trends
In comparison to CVCs, PICC insertions are less invasive with decreased complication risk and the PICC can remain indwelling for a longer duration than other acute central or periphery access devices.
Peripherally inserted central catheters are used to obtain central venous access in patients undergoing treatment in acute care facilities, home health agencies, cancer centers and skilled nursing care in a variety of settings. PICC typical indications are long-term chemotherapy, hyper-alimentation, antibiotic therapy, repeated infusion of blood or blood products, venous blood sampling, reduced number of needle punctures to skin and measurement of central venous pressure among others.
The PICC is usually placed today using an ultrasound technology to visualize a deep, large vessel in the upper arm and it is inserted by a specially trained and certified PICC nurse specialist or interventional radiologist. After the insertion, a chest x-ray can be obtained to confirm the correct placement. The entire procedure can be done in a patient’s room decreasing discomfort, transportation and inefficiencies of nursing care. Ultrasound placement has been demonstrated to reduce the number of punctures per patient during insertion. The use of ultrasound is of greatest importance with those patients that are most difficult to insert (eg obese patients).
Based on this advantage of the peripheral insertion, a new family of catheters is appearing as an alternative to PICCs in those cases where the tip of the catheter can remain peripheral and does not need to go central: the midline catheters.
A useful way to differentiate those catheters can be regarding their insert location and their tip placement, as Cikautxo Medical notes:
Antimicrobial & antithrombogenic catheter trends
It is also well known that vascular access catheters are exposed to a risk factor of biofilm growth and in those cases, infections may sometimes occur causing an extra damage to patients and causing extra costs to hospitals. For this reason, in the US market, approximately two third parts of the catheters purchased have some antimicrobial and/or anti-thrombogenic performance. Europe today does not have the same legislation but some European hospitals have made their balance and have started to increase the percentage of catheters purchased with those performances.
There are different methods to kill bacteria, which generally consist of the addition of a substance to the catheter. Once this is placed inside the patient it attacks bacteria growing colony (biofilm) being created on the catheter surface. There are catheters with different active substances, some of the best known being the silver ions, antibiotics and chlorhexidines.
In some cases, the surface is treated with a non-leaching substance that kills the bacteria with no contact when it approaches to the catheter. This method does not release any substance along the vascular system of the patient and therefore less secondary effect may occur.
Some European catheter manufacturers are offering effective antimicrobial and anti-thrombogenic catheters in the European market. This is the case of Cikautxo Medical, a Basque company specialist in silicone and thermoplastic catheter manufacturing (CVC, PICC, mid-lines…) in combination with value added solutions proposals.
CEO, Iker Principe says: “Our customers, the big catheter branded manufacturers, select some of our different technologies available in order to try to differentiate themselves in the market: some of them are giving priority to the time-to-market aspect and choose a simpler technology like silver ions which we manufacture embedded into the catheter tube and accept the release of a small (always under the regulatory limits) silver quantity into the vascular system. Some other customers prefer a longer term anti-microbial / anti-thrombogenic solutions based for example on chlorhexidine and accept the potential down sides of this second leaching method (perhaps a very remote allergic anaphylactic risk). Although we also have a solution based on a cocktail of antibiotics we do not recommend them due to the tolerance that might cause in the patients and today we are focusing our efforts in new generation technologies, a non leaching ‘natural polymer’ antimicrobial coating. The natural polymer that is going to act as a ‘selective non-contact bacteria killer’ is linked into the catheter surface with a special surface activation treatment and once the complete process is finished, we post-cure the catheters to delete any possible volatile agent. The bacteria attack is made by a technology called ‘positive charge’ and it is an ionisation killing activity that emits no leaching substance into the vascular system.”