Vascular endothelium damage from catheter-induced mechanical stimulation causes catheter sleeve formation in a rabbit model

Abstract

Background:

Intravenous catheters are widely used but are often removed due to complications associated with catheter sleeve formation. A catheter sleeve can develop from a thrombus, and catheter-induced vascular endothelium damage may be a critical factor for thrombus formation. We investigated the effect of catheter-induced mechanical stimulation on venous endothelial cells and catheter sleeve formation and the efficacy of anti-thrombogenic technology for preventing catheter sleeve formation in vivo.

Methods:

We surgically implanted poly(2-methoxyethyl acrylate)-coated and uncoated catheters with and without a stylet into the right external jugular vein of a rabbit model for 14 days. Catheter sleeve formation and the ratio of residual venous endothelial cells were compared using histological examination and immunostaining with an anti-CD31 antibody, respectively.

Results:

Stiffening an uncoated catheter with a stylet induced catheter sleeve formation along more than two-thirds of the length of the catheter. The ratios of residual venous endothelial cells at the tip of uncoated catheters with and without a stylet were 3% and 36%, respectively. While poly(2-methoxyethyl acrylate) coating also reduced the ratio of venous endothelial cells at the tip of the stiffened catheter (12%), it prevented external thrombus and catheter sleeve formation.

Conclusion:

High levels of mechanical stimulation can affect catheter-related thrombosis and promote catheter sleeve formation, and anti-thrombogenic technology such as a poly(2-methoxyethyl acrylate) coating reduces thrombus formation and can prevent catheter sleeve formation on stiffened catheters. Further studies are required to determine the maximum degree of venous endothelial cell damage before catheter sleeve formation and to compare other anti-thrombogenic technologies with poly(2-methoxyethyl acrylate) for preventing catheter sleeve formation.

Keywords

Catheter sleeve endothelial cells intravenous catheter mechanical stimulation poly(2-methoxyethyl acrylate)rabbit thrombosis

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References

Forauer

Theoharis

Dasika

NL.

Jugular vein catheter placement: histologic features and development of catheter-related (fibrin) sheaths in a swine model. Radiology 2006; 240(2): 427–434.

Lowell

Bothe

Jr.

Central venous catheter related thrombosis. Surg Oncol Clin North Am 1995; 4: 479–492.

Damascelli

Patelli

Frigerio

, et al. Placement of long-term central venous catheters in outpatients: study of 134 patients over 24,596 catheter days. AJR Am J Roentgenol 1997; 168(5): 1235–1239.

Cardella

Lukens

Fox

PS.

Fibrin sheath entrapment of peripherally inserted central catheters. J Vasc Interv Radiol 1994; 5(3): 439–442.

Brismar

Hardstedt

Jacobson

Diagnosis of thrombosis by catheter phlebography after prolonged central venous catheterization. Ann Surg 1981; 194(6): 779–783.

Raad Luna

Khalil

Costerton

, et al. The relationship between the thrombotic and infectious complications of central venous catheters. JAMA 1994; 271(13): 1014–1016.

Peters

Bush

Jr McIntyre

, et al. The development of fibrin sheath on indwelling venous catheters. Surg Gynecol Obstet 1973; 137(1): 43–47.

Xiang

Verbeken

Van Lommel

, et al. Sleeve-related thrombosis: a new form of catheter-related thrombosis. Thromb Res 2001; 104(1): 7–14.

Xiang

Verbeken

Van Lommel

, et al. Composition and formation of the sleeve enveloping a central venous catheter. J Vasc Surg 1998; 28(2): 260–271.

10.

Curelaru

Gustavsson

Hansson

, et al. Material thrombogenicity in central venous catheterization II. A comparison between plain silicone elastomer, and plain polyethylene, long, antebrachial catheters. Acta Anaesthesiol Scand 1983; 27(2): 158–164.

11.

Kohler

Kirkman

TR.

Central venous catheter failure is induced by injury and can be prevented by stabilizing the catheter tip. J Vasc Surg 1998; 28(1): 59–65; discussion 65–66.

12.

Everitt

NJ.

Effect of prolonged infusion on vein calibre: a prospective study. Ann R Coll Surg Engl 1999; 81(2): 109–112.

13.

Murayama

Takahashi

Tanabe

, et al. The relationship between the tip position of an indwelling venous catheter and the subcutaneous edema. Biosci Trends 2015; 9(6): 414–419.

14.

Tanaka

Motomura

Kawada

, et al. Blood compatible aspects of poly(2-methoxyethylacrylate) (PMEA)—relationship between protein adsorption and platelet adhesion on PMEA surface. Biomaterials 2000; 21(14): 1471–1481.

15.

Stenqvist

Curelaru

Linder

, et al. Stiffness of central venous catheters. Acta Anaesthesiol Scand 1983; 27(2): 153–157.

16.

Klement

Berry

, et al. Chronic performance of polyurethane catheters covalently coated with ATH complex: a rabbit jugular vein model. Biomaterials 2006; 27(29): 5107–5117.

17.

Crain

Horton

Mewissen

MW.

Fibrin sheaths complicating central venous catheters. AJR Am J Roentgenol 1998; 171(2): 341–346.

18.

Borow

Crowley

JG.

Prevention of thrombosis of central venous catheters. J Cardiovasc Surg 1986; 27: 571–574.

19.

Grigorian

Chen

, et al. Novel endovascular technique for removal of adherent PICC. J Vasc Access 2016; 17(6): e153–e155.

20.

Luo

, et al. Effect of mannitol injection by intravenous catheter on ear vein endothelial cell apoptosis and venous thrombus in rabbits. Eur Rev Med Pharmacol Sci 2015; 19(3): 491–497.

21.

Tanabe

Murayama

Yabunaka

, et al. Low-angled peripheral intravenous catheter tip placement decreases phlebitis. J Vasc Access 2016; 17(6): 542–547.

22.

Brisbois

Handa

Meyerhoff

. Recent advances in hemocompatible polymers for biomedical applications. In: Puoci

(ed.) Advanced polymers in medicine. Cham: Springer International Publishing, 2015, pp. 481–511.

23.

Saito

Motoyama

Sawamoto

Effects of new polymer-coated extracorporeal circuits on biocompatibility during cardiopulmonary bypass. Artif Organs 2000; 24(7): 547–554.

24.

Sylvia

Jr Wagel

Giare-Patel

, et al. Chlorhexidine-coated peripherally inserted central catheters reduce fibroblastic sleeve formation in an in vivo ovine model. J Vasc Access 2018; 19(6): 644–650.

25.

O’Farrell

Griffith

Lang

CM.

Histologic development of the sheath that forms around long-term implanted central venous catheters. JPEN J Parenter Enteral Nutr 1996; 20(2): 156–158.

26.

Brisbois

Major

Goudie

, et al. Attenuation of thrombosis and bacterial infection using dual function nitric oxide releasing central venous catheters in a 9day rabbit model. Acta Biomater 2016; 44: 304–312.