Vascular endothelium damage from catheter-induced mechanical stimulation causes catheter sleeve formation in a rabbit model.
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.
['Tanabe|Hidenori|H|https://orcid.org/0000-0001-5616-4694', 'Takemura|Naoto|N|', 'Terao|Hisako|H|', 'Hagiwara|Hitomi|H|', 'Zushi|Yasunobu|Y|', 'Murayama|Ryoko|R|', 'Abe-Doi|Mari|M|', 'Sanada|Hiromi|H|https://orcid.org/0000-0003-1912-1251']
D000179:Acrylates D000818:Animals D002405:Catheterization, Central Venous D002408:Catheters, Indwelling D062905:Central Venous Catheters D020099:Coated Materials, Biocompatible D004730:Endothelium, Vascular D004867:Equipment Design D005343:Fibrinolytic Agents D007601:Jugular Veins D010812:Physical Stimulation D011108:Polymers D011817:Rabbits D013997:Time Factors
mechanical stimulation Catheter sleeve rabbit intravenous catheter endothelial cells poly(2-methoxyethyl acrylate) thrombosis