Hydrophobic and chlorhexidine-coated peripherally inserted central catheters did not significantly reduce device failure rates compared to standard polyurethane peripherally inserted central catheters, with catheter occlusion being notably higher in the chlorhexidine group, according to a recent study.
Researchers conducted a randomized controlled trial to evaluate whether hydrophobic and chlorhexidine-coated peripherally inserted central catheters (PICCs) reduce device failure compared to standard polyurethane PICCs. This multicenter study, published in The New England Journal of Medicine, was conducted across three Australian tertiary hospitals and included 1,098 participants (83.8% adults, 16.2% pediatric patients) randomized equally into three groups: hydrophobic, chlorhexidine, and standard polyurethane PICCs.
The primary outcome was device failure, defined as infectious (e.g., bloodstream infections) or noninfectious (e.g., thrombosis, occlusion, or breakage) complications necessitating catheter removal. Participants were monitored for eight weeks or until catheter removal. Device failure occurred in 5.9% (21/358) of participants in the hydrophobic group, 9.9% (36/363) in the chlorhexidine group, and 6.1% (22/359) in the standard polyurethane group. The risk difference between hydrophobic and standard polyurethane PICCs was −0.2 percentage points (95% confidence interval [CI], −3.7 to 3.2; P = 0.89), and between chlorhexidine and standard polyurethane PICCs, it was 3.8 percentage points (95% CI, −0.1 to 7.8; P = 0.06). Odds ratios for device failure were 0.96 (95% CI, 0.51 to 1.78) for hydrophobic versus standard polyurethane PICCs and 1.71 (95% CI, 0.98 to 2.99) for chlorhexidine versus standard polyurethane PICCs.
Complications from any cause were reported in 21.5% of participants in the hydrophobic group, 38.6% in the chlorhexidine group, and 21.7% in the standard polyurethane group. Catheter occlusion was the most frequent complication, occurring in 17.0% of hydrophobic PICCs, 33.6% of chlorhexidine PICCs, and 14.2% of standard polyurethane PICCs. The study noted that the higher occlusion rates with chlorhexidine-coated PICCs may result from interactions between the chlorhexidine acetate coating and complex infusates, though further investigation is warranted. Infectious complications, including bloodstream infections, were infrequent and similar across groups.
No adverse events were attributed to the interventions, as determined by the study’s medical monitor, indicating the safety of the PICC materials evaluated.
The researchers highlighted limitations, including reliance on clinical presentation for detecting device failure and potential influences from practitioner unfamiliarity with the new devices. These factors may have impacted the results.
The growing use of PICCs across health care settings reflects efforts to manage stable and safe administration of treatments. Preventing complications such as occlusion and infection remains complex, highlighting the importance of evaluating emerging technologies before clinical adoption.
The researchers concluded that neither hydrophobic nor chlorhexidine-coated PICCs demonstrated superiority over standard polyurethane PICCs in reducing device failure. The notably higher catheter occlusion rates observed with chlorhexidine-coated PICCs highlight the complexity of addressing multifactorial complications.
Full disclosures can be found in the published study.
