Preventing radial arterial catheter failure in critical care — Factoring updated clinical strategies and techniques
Highlights
- Polyurethane (PUR), Polyether Block Amide (PEBA) and Polytetrafluoroethylene (PTFE) are thermoplastic elastomers, commonly used for intravascular catheters.
- PUR formulations cover an extremely wide range of stiffness, hardness, and densities, providing good biocompatibility, flexural endurance, high strength, and versatility. PUR elastomers have molecular structures like that of human proteins, making this material an ideal candidate for a variety of medical applications requiring adhesive strength and unique biomimetic and antithrombotic properties
- PEBA is a high-performance thermoplastic elastomer. It is used to replace common elastomers (thermoplastic polyurethanes, polyester elastomers, and silicones) because of its superior mechanical and dynamic properties (flexibility, impact resistance, fatigue resistance), better resistance against a wide range of chemical substances, no yellowing after UV exposition and good tactile feeling
- PTFE or most known as Teflon™, is hydrophobic to water, alcohols and other highly polar oxygen and hydroxyl-containing compounds. Teflon™ has a very low coefficient of friction and is relatively thermoplastic due to the bonding structure of the carbon to chlorine bonds, allowing Teflon™ to be formed into a multitude of shapes. The overall chemical structure of PTFE is very stable and is not very reactive to chemical agents, increasing its durability
- A PUR arterial catheter may kink and become non-functional due to the softer nature of the material, as opposed to a PEBA-made device, which offers improved kink-resistance (Fig. 5a & b). Kinking is frequently seen when clinicians use standard peripheral IV catheters for arterial cannulation, while PTFE offers potentially greater resistance to chemicals and improved hydrophobic properties, which may reduce cellular adhesion to the catheters external wall. The authors consider kinking of RACs inserted with a higher angle of insertion may also be related to catheter construction materials, emphasizing that the use of regular peripheral IV catheters is not appropriate for arterial cannulation practices.
- Despite the belief of greater security, the traditional approach of suturing is now considered an outdated practice, with the availability of newer and safer devices. Sutures are no longer considered an appropriate securement method and are associated with increased site-related bleeding, the need for repeated dressing changes, potential for needlestick injuries, the growth of biofilm, an increased risk of catheter-associated bloodstream infection (CABSI) and lastly, should be best avoided in accordance with current standards of practice (and supported with level II evidence)
- The insertion of a RAC within 2 cm from the transverse crease of the wrist is associated with an increased risk of complications. This area is unfavorable for an adequate securement; moreover, ROM and the use of physical restraints may contribute to premature catheter loss [4], [5], [21], [34]. There is increasing evidence and recommendations supporting avoidance of device insertion in areas of flexion with peripheral catheters, due to the increased risk of dislodgement, mechanical failures, and infectious complications
- Recent studies investigated the relocation of the catheter insertion site 4−10 cm from the wrist crease [5], [21]. The results demonstrated that with radial artery cannulation at a distance of at least 4 cm from wrist, in an area where arterial caliber, catheter, tubing and dressing are more stable and less influenced from wrist joint movement, could increase catheter durability and functionality in ICU patients
- Moving the insertion site proximally 4−5 cm from the wrist crease area may reduce accidental nerve injury and mechanical complications associated with wrist movements, preserving catheter performance, and improving overall dwell times
Preventing radial arterial catheter failure in critical care — Factoring updated clinical strategies and techniques
Highlights
- Polyurethane (PUR), Polyether Block Amide (PEBA) and Polytetrafluoroethylene (PTFE) are thermoplastic elastomers, commonly used for intravascular catheters.
- PUR formulations cover an extremely wide range of stiffness, hardness, and densities, providing good biocompatibility, flexural endurance, high strength, and versatility. PUR elastomers have molecular structures like that of human proteins, making this material an ideal candidate for a variety of medical applications requiring adhesive strength and unique biomimetic and antithrombotic properties
- PEBA is a high-performance thermoplastic elastomer. It is used to replace common elastomers (thermoplastic polyurethanes, polyester elastomers, and silicones) because of its superior mechanical and dynamic properties (flexibility, impact resistance, fatigue resistance), better resistance against a wide range of chemical substances, no yellowing after UV exposition and good tactile feeling
- PTFE or most known as Teflon™, is hydrophobic to water, alcohols and other highly polar oxygen and hydroxyl-containing compounds. Teflon™ has a very low coefficient of friction and is relatively thermoplastic due to the bonding structure of the carbon to chlorine bonds, allowing Teflon™ to be formed into a multitude of shapes. The overall chemical structure of PTFE is very stable and is not very reactive to chemical agents, increasing its durability
- A PUR arterial catheter may kink and become non-functional due to the softer nature of the material, as opposed to a PEBA-made device, which offers improved kink-resistance (Fig. 5a & b). Kinking is frequently seen when clinicians use standard peripheral IV catheters for arterial cannulation, while PTFE offers potentially greater resistance to chemicals and improved hydrophobic properties, which may reduce cellular adhesion to the catheters external wall. The authors consider kinking of RACs inserted with a higher angle of insertion may also be related to catheter construction materials, emphasizing that the use of regular peripheral IV catheters is not appropriate for arterial cannulation practices.
- Despite the belief of greater security, the traditional approach of suturing is now considered an outdated practice, with the availability of newer and safer devices. Sutures are no longer considered an appropriate securement method and are associated with increased site-related bleeding, the need for repeated dressing changes, potential for needlestick injuries, the growth of biofilm, an increased risk of catheter-associated bloodstream infection (CABSI) and lastly, should be best avoided in accordance with current standards of practice (and supported with level II evidence)
- The insertion of a RAC within 2 cm from the transverse crease of the wrist is associated with an increased risk of complications. This area is unfavorable for an adequate securement; moreover, ROM and the use of physical restraints may contribute to premature catheter loss [4], [5], [21], [34]. There is increasing evidence and recommendations supporting avoidance of device insertion in areas of flexion with peripheral catheters, due to the increased risk of dislodgement, mechanical failures, and infectious complications
- Recent studies investigated the relocation of the catheter insertion site 4−10 cm from the wrist crease [5], [21]. The results demonstrated that with radial artery cannulation at a distance of at least 4 cm from wrist, in an area where arterial caliber, catheter, tubing and dressing are more stable and less influenced from wrist joint movement, could increase catheter durability and functionality in ICU patients
- Moving the insertion site proximally 4−5 cm from the wrist crease area may reduce accidental nerve injury and mechanical complications associated with wrist movements, preserving catheter performance, and improving overall dwell times