Coated CVC and Complications: Systematic Review with ☸️SAIMSARA.

saimsara.com

Review Stats

Generated: 2025-10-06 17:46:32 CEST
Plan: Premium (expanded craft tokens; source: Europe PMC)
Source: Europe PMC
Scope: All fields
Keyword Gate: Fuzzy (≥60% of required terms, minimum 2 terms matched in title/abstract)
Total Abstracts/Papers: 596
Downloaded Abstracts/Papers: 596
Included original Abstracts/Papers: 28
Total study participants (naïve ΣN): 3851

Outcome-Sentiment Meta-Analysis (OSMA): (LLM-only)
Frame: Effect-of Predictor → Outcome • Source: Europe PMC
Outcome: complications Reported metrics: %, CI, p.
Common endpoints: Common endpoints: complications, los.
Predictor: coated CVC — exposure/predictor. Typical comparator: uncoated catheters, the control group, control, noncoated cvcs….

1) Beneficial for patients — complications with coated CVC — [4], [5], [6], [9], [12], [18], [19], [23], [24], [26], [27] — ΣN=726
2) Harmful for patients — complications with coated CVC — [16] — ΣN=101
3) No clear effect — complications with coated CVC — [1], [2], [3], [7], [8], [10], [11], [13], [14], [15], [17], [20], [21], [22], [25], [28] — ΣN=3024

1) Introduction
Central venous catheters (CVCs) are indispensable medical devices for patient management across various clinical settings, enabling drug administration, fluid resuscitation, and hemodynamic monitoring. Despite their utility, CVCs are associated with significant complications, primarily catheter-related bloodstream infections (CRBSIs) and thrombosis. These complications contribute to increased morbidity, mortality, and healthcare costs. The development of CVCs with specialized coatings represents a promising strategy to mitigate these adverse events by conferring antimicrobial, antithrombotic, or dual-action properties to the catheter surface. This paper synthesizes current evidence on the efficacy and implications of coated CVCs in reducing complications.

2) Aim
This paper aims to systematically review and synthesize the available evidence on the effectiveness of coated central venous catheters in reducing complications, specifically focusing on infection and thrombosis, as well as to identify relevant research gaps and clinical implications.

3) Methods
This rapid systematic review was conducted using an autonomous multilayer AI research agent (SAIMSARA) for keyword normalization, retrieval & structuring, and paper synthesis.

3.1 Eligibility criteria: Original studies investigating coated CVCs and their associated complications were included. Reviews, editorials, and conference papers were excluded. Studies were selected based on their relevance to the "coated CVC and complications" query.

3.2 Study selection: Study selection was performed by applying a strict keyword gate during the initial retrieval phase, as managed by the SAIMSARA agent. The structured summary provided contains the filtered Original Studies.

3.3 Risk of bias: The risk of bias was qualitatively inferred from the available study design fields. Randomized controlled trials (RCTs) [1, 11, 19, 23, 26] were considered to offer the highest level of evidence, while cross-sectional [2], experimental [6], synthetic/simulation [15, 25], and mixed-design studies [7, 8, 10, 12, 13, 14, 16, 17, 18, 20, 21, 22, 24, 27, 28] were noted for their varying methodological strengths and limitations. Studies not specifying a design [3, 4, 5, 9] or population [3, 4, 5, 9] were generally considered to have a higher potential for bias or limited generalizability.

3.4 Synthesis: The synthesis of findings was performed by an autonomous multilayer AI research agent, which conducted keyword normalization, retrieval & structuring, and subsequent paper synthesis (see SAIMSARA About section for details).

4) Results

4.1 Study characteristics: The included studies comprised a diverse range of designs, including prospective randomized controlled trials [1, 19, 23], cross-sectional studies [2], experimental designs [6], synthetic/simulation studies [15, 25], and various mixed-design or unspecified studies [3, 4, 5, 7, 8, 9, 10, 12, 13, 14, 16, 17, 18, 20, 21, 22, 24, 27, 28]. Populations varied widely, encompassing cancer patients [1, 28], ICU nurses [2], pediatric surgical patients [14], hemodialysis patients [11, 13], patients undergoing major surgery [23], critically ill patients [19, 26], individuals with hematological malignancy [10], and animal models (rats, rabbits, hamsters) [18, 20, 17, 22]. Follow-up periods, when specified, ranged from 3 months [11] to 120 hours in simulation [15, 25] or 9-12 days in clinical trials [23].

4.2 Main numerical result aligned to the query:
Regarding infection-related complications, a non-leaching antibacterial coating on CVCs significantly reduced the incidence of bloodstream infections (BSI) from 6.5% to 2.0% (P=0.0081) in intensive care patients [19]. For catheter tip bacterial colonization, PHMB-coated CVCs showed a colonization rate of 2.5% compared to 4.2% for standard CVCs (p=0.10) in cancer patients [1]. Another study reported catheter colonization rates of 17.4% for non-leaching antibacterial coated CVCs versus 18.7% for standard CVCs (P=0.7477) [19]. Across these two studies, the median colonization rate for coated CVCs was 9.95% (range: 2.5–17.4%) compared to 11.45% (range: 4.2–18.7%) for standard CVCs [1, 19]. In terms of broader adverse events, a noble metal coated CVC (BIP CVC) demonstrated 0 adverse events compared to 5 adverse events in 4 patients in the standard CVC group (p=0.011) in patients undergoing major surgery [23].

4.3 Topic synthesis:

Antimicrobial Coating Efficacy: PHMB-coated CVCs numerically reduced catheter tip bacterial colonization (2.5% vs. 4.2%, p=0.10) [1], while a non-leaching antibacterial coating significantly reduced BSI (2.0% vs. 6.5%, P=0.0081) [19]. Zinc oxide nanoparticles (ZnO NPs) demonstrated 99.99% killing efficacy and prevented biofilm formation [4, 9]. Tryptophol (TOH) coating reduced fungal biofilm formation and cell viability [20].
Antithrombotic Coating Development: Heparin-network-mediated coatings reduced thrombus adhesion by 60% [6]. Bioinspired zwitterionic block polymers and nitric oxide-generating coatings were developed to combat thrombosis [5, 18]. Noble metal alloy (NMA) coated CVCs showed improved ex vivo blood compatibility with significantly lower thrombin-antithrombin complex generation and fibrin deposition [27].
Dual-Action Coating Innovations: Heparin-network-mediated coatings demonstrated both antithrombotic (60% reduction) and antibacterial (>97% activity) properties [6]. Bioinspired super-hydrophilic zwitterionic polymer armor effectively combatted thrombosis and infection [18].
Coating Efficacy Limitations: The antibacterial efficacy of chlorhexidine and silver sulfadiazine (CSS-CVC) decreased with increasing blood flow rates and prolonged duration, with antibacterial function lost after 48 hours of simulated wear-out [15, 25].
Healthcare Provider Knowledge Gaps: ICU nurses in Saudi Arabia demonstrated significant knowledge gaps regarding CVC-related infection (CVC-RI) pathophysiology (14.6% knowledge score), highlighting a need for education [2].
Clinical Risk Factors for CVC Complications: Prone positioning was associated with a higher risk of CVC infectious complications (p=0.04) [16]. In pediatric surgical patients, age (adjusted OR=0.87; p=0.009), CVC dwell time (adjusted OR=1.28; p=0.003), and femoral CVC (adjusted OR=9.61; p<0.001) were identified as independent risk factors for CRBSI [14].
Comprehensive Intervention Impact: Implementation of a comprehensive bundle, including antithrombotic and antimicrobial-coated CVCs, led to a significant reduction in central line-associated bloodstream infection (CLABSI) rates, with cases declining 68% (from 34 to 11 patients) and a 42% decrease per 1000 CVC days (from 0.624 to 0.362) [12].

5) Discussion

5.1 Principal finding:
A non-leaching antibacterial coating on central venous catheters significantly reduced the incidence of bloodstream infections from 6.5% to 2.0% (P=0.0081) in intensive care patients [19], indicating a substantial clinical benefit in preventing severe infectious complications.

5.2 Clinical implications:

Reduced Infection Risk: The use of specific antibacterial-coated CVCs can significantly lower the incidence of bloodstream infections, directly improving patient outcomes [19].
Broader Complication Prevention: Coatings designed to combat both thrombosis and infection offer a comprehensive approach to mitigating CVC-related adverse events [6, 18].
Targeted Education: Addressing knowledge gaps among ICU nurses regarding CVC-RI pathophysiology is crucial for effective prevention strategies [2].
Risk Factor Mitigation: Awareness of risk factors like prone positioning, CVC dwell time, and femoral insertion sites can guide clinical practice to reduce CRBSIs [14, 16].
Duration of Efficacy: Clinicians should be aware that the efficacy of some coated CVCs, such as chlorhexidine and silver sulfadiazine coatings, may diminish over time, potentially losing antibacterial function within 48 hours [15, 25].

5.3 Research implications / key gaps:

Standardized Efficacy Metrics: Future studies should standardize outcome metrics for infection and thrombosis to allow for robust meta-analysis across different coating types and patient populations [1, 19, 23].
Long-Term Efficacy of Coatings: Research is needed to evaluate the long-term efficacy and durability of novel coatings in vivo, particularly beyond short-term simulations [15, 25].
Comparative Effectiveness of Coating Types: Head-to-head randomized controlled trials comparing different types of antimicrobial and antithrombotic coatings (e.g., PHMB vs. noble metals vs. zwitterionic polymers) are needed across diverse patient groups [1, 19, 23].
Impact of Patient-Specific Factors: Further investigation into how patient-specific factors (e.g., gender in cancer patients [1], underlying malignancy [10, 28]) influence the effectiveness of coated CVCs is warranted.
Cost-Effectiveness Analyses: Studies are needed to assess the cost-effectiveness of implementing various coated CVC technologies in routine clinical practice, considering both device cost and complication reduction [All studies].

5.4 Limitations:

Heterogeneity of Coatings — The review encompassed a wide variety of coating types (e.g., PHMB, noble metals, zwitterionic polymers, ZnO nanoparticles), making direct comparisons and pooled effect estimates challenging.
Variability in Study Designs — Included studies ranged from in vitro experiments and animal models to small RCTs and retrospective analyses, limiting the generalizability and strength of evidence.
Inconsistent Outcome Reporting — Different studies reported diverse outcomes (e.g., catheter colonization, BSI, general adverse events, thrombus adhesion), often with varying definitions and measurement methods.
Limited Human Clinical Trials — A significant portion of the evidence, particularly for novel coating technologies, was derived from preclinical or simulation studies, with fewer large-scale human RCTs.
Lack of Long-Term Follow-up — Many studies, especially those evaluating coating durability, had relatively short follow-up periods, which may not capture all relevant long-term complications or efficacy decay.

5.5 Future directions:

Large-Scale RCTs — Conduct large, multi-center randomized controlled trials comparing specific coated CVCs against standard CVCs for hard clinical endpoints like CRBSI and thrombosis.
Novel Coating Assessment — Systematically evaluate the in-vivo efficacy and safety of promising novel coatings, such as those incorporating ZnO nanoparticles or zwitterionic polymers.
Durability Testing Protocols — Develop and implement standardized protocols for long-term durability testing of CVC coatings under simulated and actual physiological conditions.
Integrated Bundle Studies — Investigate the specific contribution of coated CVCs within comprehensive care bundles to optimize infection and complication prevention strategies.
Education Program Evaluation — Design and evaluate targeted educational programs for healthcare providers to improve knowledge and adherence to best practices for CVC management.

6) Conclusion
A non-leaching antibacterial coating on central venous catheters significantly reduced the incidence of bloodstream infections from 6.5% to 2.0% (P=0.0081) in intensive care patients [19]. While various coatings show promise in reducing infection and thrombosis across diverse populations and settings, the heterogeneity of coating types, study designs, and outcome measures limits broad generalizability. The variability in study designs, particularly the reliance on preclinical and small-scale human studies, most affects the certainty of widespread clinical efficacy. Clinicians should consider the evidence for specific coated CVCs in their patient populations, while researchers should prioritize large-scale, comparative RCTs with standardized outcomes to solidify the evidence base.

References
SAIMSARA Session Index — session.json

Figure 1. Publication-year distribution of included originals

Figure 1. Publication-year distribution of included originals

Figure 2. Study-design distribution of included originals

Figure 3. Study-type (directionality) distribution of included originals
Figure 3. Directionality distribution

Figure 4. Main extracted research topics

Figure 5. Limitations of current studies (topics)

Figure 6. Future research directions (topics)