Bunch, J
Aug 16, 2024
JIN Manuscript
The Art and Science of Infusion Nursing
OPEN
270 Copyright © 2020 The Author. Published by Wolters Kluwer Health, Inc. Journal of Infusion Nursing
on behalf of the Infusion Nurses Society.
BACKGROUND
In 2016, approximately 95% of all peripherally inserted
central catheters (PICCs) were composed of polyurethane
(PU). 1 PU has been used to manufacture vascular access
devices (VADs) for decades, during which it has been thor-
oughly studied and considered generally well tolerated.
Safety and efficacy issues commonly reported include
catheter dysfunction, phlebitis, and thrombosis. 2 Low
water content of a foreign object introduced into the body
is a significant trigger to systemic reaction. The structural
makeup of PU is hydrophobic, causing the body to react to
the material leading to protein adherence. 3 In addition to
protein adhering to hydrophobic material, the introduction
of such material into the bloodstream increases the likeli-
hood of inflammatory cell adhesion and surface-induced
thrombosis. 4
The medical device industry has used PU as a base
substance to mitigate some intrinsic issues found in hydro-
phobic materials. Hydrophilic polymers and hydrogels have
been grafted onto medical devices to decrease throm-
bogenicity. 3 , 5 In the vascular access industry, engineers
have added fluoro-oligomer to modify the PU (MPU),
impregnated the catheter with antibiotics, and coated the
devices with antithrombogenic or antimicrobial properties
( Figure 1 ). 6-8 Hydrophobic surfaces create high energy,
which attracts proteins and cells floating by as the body
responds to the apparent foreign object. Lowering the
surface energy of PU by adding fluoro-oligomer can lower
adhesion while the catheter remains hydrophobic. 3 , 5 The
other option is to change the surface energy by using a
different base material that is hydrophilic. 3
One alternative material to PU currently on the mar-
ket in the United States is polyvinyl alcohol (PVA)–based
ABSTRACT
Vascular access specialists are responsible for assessing the patient in their unique situation and determining the
correct vascular access device to complete the therapeutic goal without complication or failure. This retrospective
cohort study compared the failure rates of a variety of polyurethane (PU) midline catheters and a midline catheter
constructed of an emerging hydrophilic biomaterial (HBM). A total of 205 patients received a midline catheter and
were situationally randomized by the facility where they received it. Patients who had received a midline catheter
between March 2021 and May 2021 were assessed for catheter-related failures leading to increased staff time,
delays in treatment, or replacement with a new vascular access device to complete the therapy. There were 101
patients in the PU cohort and 104 patients in the HBM cohort. Comparing overall failure rates between the groups
revealed a 23.8% failure rate in the PU control group and only a 3.8% failure rate in the HBM group. This suggests
that a midline catheter constructed of HBM biomaterial is associated with significantly lower rates of failure, thereby
improving patient experience and health care economics.
Key words: catheter , complication , failure , hydrogel , hydrophilic , hydrophobic , material , midline , polyurethane
Author Affiliation: ProVasc Ltd, Romeoville, Illinois.
Joseph Bunch, RN, is the chief executive officer and principal
owner of ProVasc Ltd, a Chicagoland-based vascular access group.
He is responsible for the strategic direction, vision, and clinical
performance of the group. As a registered nurse for more than 22
years, he has placed more than 50 000 vascular access devices.
Disclosures: Financial support for data mining and statistical anal-
ysis was provided by Access Vascular Inc (Billerica, MA, USA) after
all data for the vascular access devices were recorded. No off-label
or investigative actions were part of this study .
This is an open-access article distributed under the terms of the
Creative Commons Attribution-Non Commercial-No Derivatives
License 4.0 (CCBY-NC-ND), where it is permissible to download
and share the work provided it is properly cited. The work cannot
be changed in any way or used commercially without permission
from the journal.
Corresponding Author: Joseph Bunch, RN, ProVasc Ltd, 1079
Redondo Dr, Romeoville, IL 60446 ( admin@picclines.net ).