Background: Peripherally inserted central catheters (PICCs) are associated with an increased risk of central line-associated bloodstream infection (CLABSI) and venous thromboembolism (VTE). Catheters that are coated or impregnated with antimicrobial and/or antithrombotic agents have been developed to prevent these complications. However, their effectiveness in preventing CLABSI and VTE is unclear. Using data from a large multi-institutional quality collaborative, we evaluated the efficacy of coated PICCs in preventing these major complications.

Methods: From April 2015 to October 2019, trained abstractors prospectively collected demographic and clinical information on a sample of PICC placements at 52 hospitals participating in the state-wide Michigan Hospital Medicine Safety consortium. Patients were followed until PICC removal, death, or 70 days after insertion. Multivariable Cox regression models were fit to assess association between use of a coated catheter (defined as PICCs coated or impregnated with heparin, Endexo ®, minocycline-rifampin, silver-sulfadiazine, or chlorhexidine-gluconate compounds) and each of the following complications: central line-associated bloodstream infection (based on National Healthcare Safety Network or Infectious Diseases Society of America criteria), symptomatic venous thromboembolism (defined as clinically diagnosed deep vein thrombosis and/or pulmonary embolism, not present at the time of PICC placement and confirmed by imaging) and catheter occlusion. Results were expressed as odds ratios (ORs) with corresponding 95% confidence intervals (CIs). Subgroup analyses were performed in high-risk populations including patients where PICCs were placed in the intensive care unit (ICU) and those receiving systemic chemotherapy.

Results: Of the 45,680 PICCs placed, 2,419 (5.3%) had antimicrobial coating, 959 (2.1%) had an antithrombotic coating, and 2,924 (6.4%) had antimicrobial and/or antithrombotic coating. A total of 12,711 (27.8%) were placed in the ICU and 1,634 (3.6%) were placed in patients receiving chemotherapy. In the overall cohort, CLABSI occurred in 838 (1.8%), VTE in 597 (1.3%), and catheter occlusion in 4,466 (9.8%) patients (Table 1). Compared to non-coated catheters, coated PICCs were not associated with a reduction in the risk of CLABSI (OR 1.09, 95% CI 0.78 to 1.52). Similarly, antithrombotic coating was not associated with a significant reduction in the risk of VTE (OR 0.80, 95% CI 0.43 to 1.50), or catheter occlusion (OR 1.22, 95% CI 0.98 to 1.53). Subgroup analyses in critically ill patients in the ICU and in PICCs placed in patients receiving chemotherapy revealed no association between catheter coating and the occurrence of CLABSI, VTE or catheter occlusion (Table 2).

Conclusions: In this analysis of 45,680 PICCs, including 2,419 coated devices – no reduction in the rates of major catheter complications including CLABSI, VTE and catheter occlusion were observed in patients that received antimicrobial or antithrombotic coated PICCs. Randomized trials assessing the benefits of these devices appear necessary.

IMAGE 1: Table 1. Rates of peripherally inserted central catheter complications

IMAGE 2: Table 2. Association between catheter coating and peripherally inserted central catheter complications