Polyurethane Catheters and Alcohol |
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| Question: |
We currently use many central venous catheters made of polyurethane for our PICCs, midlines, and nontunneled catheters. Many of these catheters have strong statements warning about use of alcohol with the catheter. We have noticed these warnings because we are expected to use more alcohol around the insertion site for skin antisepsis and removing catheter securement devices. What type of catheter damage will result when alcohol is used on polyurethane catheters? How frequently does this occur? Are there techniques we can we use to avoid catheter damage? |
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| Answer: |
You have identified a serious conflict between recommendations of several product manufacturers. Alcohol has long been regarded as an excellent skin antiseptic agent as it has microbicidal activity against gram- positive and gram-negative bacteria, viruses and fungi. Several antiseptic solutions are actually combinations of alcohol and other agents such as chlorhexidine (Chloraprep®) and iodine (Persist Plus ®). These solutions are critical components to reducing the inordinately high rate of catheter-related bloodstream infections. Currently nosocomial bloodstream infections ranks as the eighth leading cause of death in the US with catheter-related bloodstream infections responsible for 70% of these nosocomial infections.
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| Alcohol is also used as a solvent for adhesives used on catheter securement devices. The alcohol use prevents inadvertent skin damage when the securement device is removed. But this partly explains the problem – alcohol will dissolve some substances. |
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| Catheters made from older types of polyurethane cannot tolerate alcohol easily. If the catheter manufacturer is making strong statements against alcohol, you must be using a catheter made from the original type of polyurethane. There are actually three “generations” of polyurethane used to manufacture catheters. The first generation presents the greatest problem with alcohol use, however the second and third generation of polyurethane is more tolerant of alcohol and has less stress cracking. |
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| The test conducted on polyurethane is performed with pellets of the chosen material. These pellets are placed in a bath of a variety of solvents, one of which is isopropyl alcohol. The older types of polyurethane will absorb the alcohol and swell significantly. When dried, these pellets do not return to their original size and may have a tacky feel. This can lead to stress cracks in the material. It is important to remember that these tests are done on the pellets, not the extruded tubes or the assembled catheters. |
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| When we look at the complications of catheters, there is a lot of evidence that catheters break, rupture, or fracture. Use of alcohol in the clinical setting has never been directly correlated as the cause of catheter damage. In theory, some of this damage could be caused by alcohol use, however we do not have good evidence to support this theory. In my mind, the question then becomes - do the test conducted on these pellets adequately reflect the ways we use alcohol in the clinical environment? How much contact with alcohol is required before catheter damage is seen? Is this a number of contacts or a length of time for contact? So your question about the type and frequency of catheter damage from alcohol cannot be answered. |
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| contentCatheter manufacturers are using two different strategies for addressing this issue. Some have conducted additional testing on their catheters and have written new instructions for use. These statements usually allow cleaning the skin around the catheter with alcohol, prohibit applying alcohol directly to the external catheter, and require that the area be thoroughly dry before applying the new dressing. The other strategy is to construct catheters with newer formulations of polyurethane that has a greater tolerance for alcohol. |
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| Both of these strategies require time to implement. After new instructions for use are written, the package insert must be printed and packaged with the product. Building products with a different type of polyurethane requires the entire product development process. |
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| When writing policies and procedures for catheter insertion and care, you will need to have the latest instructions for use document packaged with every catheter. Check the publication date on the back of these documents periodically to make sure you have the latest version. Read the section on warnings or precautions. If your questions are still unanswered, contact the manufacturer to request written answers to your questions. They may have a memo that can be shared with you as an interim step until the new statements are included in the products being shipped out. |
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| Alcohol is a critical component for reducing catheter-related infections and to remove adhesives preventing skin damage. I would direct these questions to the manufacturer of the catheter. The standard of practice calls for you to follow the manufacturers guidelines, however you cannot ignore the evidence supporting methods that will reduce catheter-related infection and promote skin integrity. |
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1. Maury, E. Guliekminotti, J. Alzieu, M. Guidet, B. Offenstadult, G. Ultrasonic examination: An alternative to chest radiography after central venous catheter insertion? American Journal of Respiratory Critical Care Medicine 2001; 164(3): 403-405.
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| This article was originally published in the Catheter Connection column of the Journal of Vascular Access Devices. For more information about the National Association of Vascular Access Networks, visit http://www.navannet.org |
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LYNN HADAWAY ASSOCIATES ©2001 |
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