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Oncology Ambula...
Antibiotic coated PICC's

Is anyone familiar with Cook's Rifampin/Monocycline coated catheter. Any data available to support use. If it is so great than wouldn't we all be users!

We have also looked at Cook's Power injectable PICC and I must say it feels softer to the touch than Bards Power PICC(perhaps because it's not colored?) Any feedback on either of these catheters would be appreciated!

Thanks, Karen

amymilburn
Karen, I kind of think the

Karen,

I kind of think the coated PICC idea is over kill.  PICC infection rates are so low.  I too have seen the Cook Power PICC.  It did seem a little softer.  My only concern was that the injection rates were different for each size, which may be confusing for CT.  Also, they did not have a safety kit.  Good luck.  Amy

lynncrni
I have a different

I have a different opinion.  Infection rates with PICCs in hospitalized patients are not so low. In fact they are about the same as any other non-tunneled CVC. So a PICC with an antimicrobial impregnated into it is a very good thing. MD Anderson has done lots of studies and published on these catheter extensively.

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Jefferson
Hi Lynn,   I'm not sure

Hi Lynn,  

I'm not sure about antibiotics being the antimicrobial treatment of choice for PICCs, in part because of the number of patients receiving chemo with very compromised immune systems.  Multiple studies, even some sponsored by Cook but not widely distributed, have shown a tendency toward higher rates of Candida and Pseudomonas infections in CVCs with the Spectrum coating.  I can get those to you if you'd like.  I believe that Candida infections have a mortality rate in the neighborhood of 40%.

The same researchers at MD Anderson who received royalties as co-inventors of the technology are co-authors of seven of the twelve sources in the Cook Spectrum brochure, but those same researchers have since switched their focus to other types of antimicrobial compounds, most including Chlorhexidine.  If I have my facts right, one of the studies by Drs. Raad and Darouiche at Anderson that shows effectiveness against Candida actually evaluated a formulation different from that eventually used in Spectrum catheters. 

I am an industry rep so of course I have bias on this issue, but at the same time this is what has propelled me to learn as much as possible on the topic.

Of course, I am open to your comments -

Jeff

 

IVRN
The other important thing to
The other important thing to note about Cook's Spectrum PICC lines is that they are SILICONE, not polyurethane.  I do not think that I would like to trade the very real possiblity of breakage, bleeding through the line and air embolism for the relative safety that the antibiotic gives on the PICC.  I think using a Biopatch at the site gives extra antimicrobial protection, including against psudomonas and candida and I do not have to go back to using silicone with the risks that it involves.
kokotis
Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

Cook and Spectrum was released at least a decade ago onthe acute care CVC's up against competitiors like Arrow's coating.  Bottom line although the clinical data is very good (Dr. Raad/Dauroiche out of Texas)  on skin organisms and efficacy over longer periods of time versus the Arrowguard the main issue is one of material compostion.  MD's prefer to insert catheters that can be forced in fast and thread easily.  The stiffer the better.  Yes it is true.  In fact one of the techniques believe it or not with the Arrow PICC is to place the PICC without a dilator/introducer.  Yes it is true.  So stiff it can be shoved in over a wire and that is an advantage to some MD's.  This was a disadvantage for the silicone spectrum catheter regardless of efficacy of coating.  Silicone cannot be shoved in. 

PICC lines are poly and siicone in base however they are small gauges.  The acute care CVC's are big and can stand the coating without fracture/breakage.  There will be a future and it is needed as PICC lines are not innocuous for a dipped or bonded coating however it is a matter of establishing the right coating for the material to get the best dwell outcome results.  There was a bonded coated PICC catheter in the US under trials 8 years ago you will remember.  It was black in color but very stiff.  Implemed was the company.  Great concept, good data, it had lots of stress fractures.

The balance of a coating, catheter material and safety is difficult for a PICC line

Kathy 

 

Kathy Kokotis

Bard Access Systems

Cindy Schrum
Cindy Schrum RN CRNI  I

Cindy Schrum RN CRNI

 I have to comment of Kathy's 'yes it's true!"  statements about the Arrow Piccs.  Kathy isn't exactly speaking from the realm of experience.  I've inserted hundreds and hundreds of both Bard and Arrow catheters. 

The technique that she is speaking of is the 'over-the-wire' technique that some physicians use.  What aids them in advancing the catheter in this manner is the pointed, soft blue tip of the catheter.  Because of the shape of the tip, it advances easily.  The softness of the tip helps to protect the delicate endothelium of the vessel.  It is the stiffness of a guidewire, not the catheter itself that allows the physician to advance the catheter. 

Kathy, the next time you are at the bedside inserting Piccs, I invite you to try to insert an Arrow Picc without the stylet wire and do the same with the Bard Picc.  If catheter 'stiffness' is a term you want to use for comparison, you will undoubtedly see the purple Picc wins.

You also mentioned the smaller gauge of Piccs.  Arrow Piccs are labeled 5fr and 4fr are actually just that.  Tip to hub.  5 fr doesn't become 6.5 fr and 6fr doesn't become 7.5 fr.  Neither does Arrow have the so-called 'taper' that begins at 9 cm and gradually increases to the hub, dwelling in the smallest portion of the accessed vessel.

Arrow has many, many studies showing the effectiveness of the antimicrobial centrals.  A low infection rate is no longer acceptable.  Zero is the target.

Please email me privately and I will be happy to share more specific information about the effectiveness of chlorhexidine and silver sulfadiazine on the Arrow central catheters. 

Cindy Schrum RN CRNI

Arrow International

Senior Clinical Specialist

[email protected]

 

 

 

Cindy Schrum RN CRNI

Jefferson
Kathy, are you really

Kathy, are you really saying that 80% of the triple lumen CVC's placed in the US are Arrow's because they are stiffer?  This despite some kind of weakness in performance?

If you think Darouiche and Raad, NEJM, 1999, is relevant today, it isn't.  Actually, I really wouldn't blame you for thinking it is, because it's still the centerpiece of Cook's marketing for Spectrum CVC's and a lot of people are fooled.  Darouiche and Raad compared Spectrum to 1st generation ArrowGard which was improved on 8 years ago with ArrowGard Blue Plus.  This is a fact conveniently omitted.  It's like comparing a high defininition TV to an 8 year old TV without tellilng anyone the other TV is 8 years old.

What is interesting about that study, however, is how the numbers play out even with Arrow's first generation catheter.  Suspected catheter infections were EQUAL, yet somehow Cook's catheter had far fewer confirmed line infections.  For my money, if the number of suspected infections is equal, I'm thinking my true CRBSI's are pretty close.  When they were culturing catheter tips to confirm infections, was there an inactivating medium used to counteract the effect of the minocycline/rifamplin on Spectrum in the dish?  Take a real good luck at that study and if you want we can talk some more.

nancymoureau
 It would be nice to see a

 It would be nice to see a head to head comparative study with Arrow Blue Guard and the Cook Spectrum now. Evidence really speaks and evaluations done at your own hospital with products such as the Cook Spectrum or the Arrow Blue Guard may provide you with convincing results.

Nancy L. Moureau, BSN, CRNI

PICC Excellence, Inc

Nancy L. Moureau, BSN, CRNI, CPUI, VA-BC

PICC Excellence, Inc

 

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