Tanabe Hidenori, Takemura Naoto, Terao Hisako, Hagiwara Hitomi, Zushi Yasunobu, Murayama Ryoko, Abe-Doi Mari, Sanada Hiromi
Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Research and Development Center, Terumo Corporation, Kanagawa, Japan.
J Vasc Access. 2020 May;21(3):379-386. doi: 10.1177/1129729819879317. Epub 2019 Oct 8.
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.
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.
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.
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.
静脉导管被广泛使用，但常因与导管套形成相关的并发症而被拔除。导管套可由血栓形成，而导管引起的血管内皮损伤可能是血栓形成的关键因素。我们研究了导管引起的机械刺激对静脉内皮细胞和导管套形成的影响，以及抗血栓形成技术在体内预防导管套形成的效果。
我们将有或无导丝的聚（丙烯酸2-甲氧基乙酯）涂层和未涂层导管手术植入兔模型的右颈外静脉14天。分别使用组织学检查和抗CD31抗体免疫染色比较导管套形成情况和残余静脉内皮细胞比例。
用导丝使未涂层导管变硬会导致沿导管长度超过三分之二的部位形成导管套。有导丝和无导丝的未涂层导管尖端残余静脉内皮细胞比例分别为3%和36%。虽然聚（丙烯酸2-甲氧基乙酯）涂层也降低了变硬导管尖端的静脉内皮细胞比例（12%），但它可防止外部血栓和导管套形成。
高水平的机械刺激会影响与导管相关的血栓形成并促进导管套形成，而诸如聚（丙烯酸2-甲氧基乙酯）涂层之类的抗血栓形成技术可减少血栓形成并能防止变硬导管上形成导管套。需要进一步研究以确定在导管套形成之前静脉内皮细胞损伤的最大程度，并将其他抗血栓形成技术与聚（丙烯酸2-甲氧基乙酯）用于预防导管套形成进行比较。
