Vascular Access Catheters

Short-Term Central Venous Catheters

Many patients who receive a Central Venous Catheter will require a CT scan. To streamline patient care, our ARROW® CVCs are now available with pressure injection capabilities; up to 10 mL/sec of contrast for CT scanning.

If a central line is not rated for pressure-injectable contrast, the patient and clinician will need to wait for a second pressure injectable vascular access device to be placed. If a Pressure Injectable ARROW® CVC is in place, the patient can be sent for CT scanning immediately. An added advantage for CT techs is that ARROW®CVCs are larger than most PICCs, you can get faster flow rates of the injected contrast.

ARROWg+ard® Technology is a chlorhexidine-based technology impregnated into the catheter surface. Chlorhexidine/silver sulfadiazine antimicrobial catheters such as ARROW® CVCs with ARROWg+ard® Technology are a CDC 1A recommendation for the prevention of catheter-related bloodstream infection. The use of ARROWg+ard® Technology can protect against infections and therefore reduces costs by reducing infection. More than 30 studies2 verify the efficacy of the ARROWg+ard® Technology against a broad-spectrum of microbial activity. The ARROW® Brand catheter with ARROWg+ard® Technology has a strong track record.

  • ARROWg+ard Blue® Technology is the 1st generation of the chlorhexidine-based antiseptic catheter. It is protected only on the outside of the catheter. ARROWg+ard Blue PLUS® Technology is protected with chlorhexidine-based technology on both the outside and inside of the catheter, the entire fluid pathway including the inside of the extension lines and hubs.
  • Maki et al. found ARROWg+ard® Technology reduces bacterial colonization of the catheter by 44 percent and catheter-related bacteremia by an even greater 79 percent.3
  • ARROWg+ard® Technology has been shown to be effective against the pathogens responsible for CLABSI (see chart below). This includes a wide array of gram-positive bacteria, including S. epidermidis, MRSAand S. aureus; gram-negative bacteria, including Enterococci and Pseudomonas strains; and fungi, including C. albicans.6
Organism5 Pathogen % of all CLABSI Proven effective in vitro6*
Gram-positive CoNS 34.1%
Enterococcus species 16.0%
Staphylococcus aureus 9.9%
Gram-negative Klebsiella species 5.8%
Enterobacter species 3.9%
Pseudomonas aeruginosa 3.1%
Escherichia coli 2.7%
Acinetobacter baumannii 2.2%
Fungi Candida species 11.8%
Total   89.5%  

* Studies were done using ARROWg+ard Blue PLUS® Technology using In Vitro zone of inhibition test. ARROWg+ard Blue PLUS® Technology showed a minimum of a 4 mm zone of inhibition at day seven.

Proven Protection Inside and Out

 

Arrow® Catheters with ARROWg+ard Blue PLUS® Technology protects both inside and out (including inside of the extension lines and hubs). Chlorhexidine preps the subcutaneous catheter tract and kills organisms in places that you can't reach. ARROWg+ard Blue PLUS® Technology also protects the catheter hub and extension lines where competitor catheters do not.

Mark E. Rupp, MD, et al., has conclusively proven the efficacy of ARROWg+ard Blue PLUS® Technology to prevent catheter colonization compared with unprotected catheters.4

What is the recommended flushing protocol for ARROW® CVCs?

Because flushing protocols differ from institution to institution and flushing requirements differ from patient to patient, there is not one recommended protocol from the manufacturer. We know that our catheters maintain patency with a variety of protocols. A good resource for flushing guidelines is the Intravenous Nurses Society (INS) Standards of Practice (www.INS1.org). The INS Policies and Procedures for Infusion Nursing, which can be purchased through the INS website, is another valuable resource. If you need help establishing a flushing protocol within your institution, our clinical support specialists can assist you. Contact our customer service team at 800-523-8446.


What is the maximum pounds per square inch (psi) that can be injected through an ARROW® CVC? Can we use a central line with a power injector?

Through its ARROW® family of Vascular Access Products, Teleflex offers a line of multi-lumen CVCs with the additional indication of high pressure injection. If your patients receive an ARROW® Pressure Injectable CVC, CT technicians will have the option of using that indwelling line without having to insert another catheter for their scan.

ARROW® Pressure Injectable CVCs are individually labeled on their extension line hubs with each lumen's maximum flow rate. Lumens are either indicated for 5 ml/sec, or 10 ml/sec. Individual lumen capabilities vary by catheter, injection pressure and ml/second, so it is important to check each catheter before considering pressure injection. The ARROW® CVCs are tested at both 300 and 400 PSIs. Additional information on catheter capabilities can be found in the product labeling. If you would like more information on ARROW® Pressure Injectable CVCs, please contact your local sales representative or customer service at 800-523-8446.

Download the ARROW® CVC Pressure Injectable Poster

For catheters and catheter lumens that do not carry the Pressure Injectable indication, ARROW® CVCs are designed so that every lumen can withstand an internal pressure of at least 50 psi. During manufacturing, every catheter is tested to 50 psi to ensure there is no intraluminal crossover or leakage. However, non-pressure injectable catheters and catheter lumens are not designed to withstand the higher pressures associated with contrast used during CT scans. The minimum strength of 50 psi allows for hand injections performed with a 10 cc or larger syringe, as indicated. ARROW® CVCs can also be used with most rapid infusers which typically utilize 5.8 psi or 300 mmHg (millimeters of mercury). (For more information, contact your rapid infuser manufacturer.)


Where do I find flow rate information and priming volumes for an ARROW® CVC?

Priming volume and flow rate information is conveniently located on the printed lidstock or in the product labeling for most ARROW® Vascular Access product. High pressure injection flow rates for CT contrast scans are found on the lidstock and catheter hubs.


What is the length of time that an ARROW® CVC can be left in a patient?

The ARROW® Central Venous Access line offers both short and long-term dwell catheter options. The ARROW® Central Venous Catheter (CVC) is indicated to provide short-term central venous access and the ARROW® JACC is indicated for long-term central venous access. Both are indicated for the treatment of diseases or conditions requiring central venous access.

Per FDA guidelines, short-term indication is any dwell time less than 30 days and long-term indication is any dwell time greater than 30 days. Every patient and clinical situation is different. Clinicians should evaluate the need for venous access against the patient's daily therapy regimen. Regardless of device indication, evidence-based recommendations should be followed.


Are ARROW® CVCs MRI compatible? Is the ARROWg+ard® Antimicrobial Technology with chlorhexidine and silver sulfadiazine also MRI compatible?

Yes. ARROW® CVCs are MRI compatible. The catheters are made entirely of polyurethane and they contain no wire or ferromagnetic material. The catheters have been tested to be compatible to use with an MRI machine. Additionally, chlorhexidine and silver sulfadiazine are organic antimicrobial compounds that do not contain wire or ferromagnetic materials, and are compatible to use during an MRI procedure.


Can the ARROW® CVC be exposed to alcohol or acetone?

The ARROW® CVC can be exposed to alcohol, but the length of the exposure is key. Brief exposure at the insertion site or during a dressing change will not compromise the integrity of the catheter. You should allow skin preps to completely dry per the manufacturer's Instructions For Use to minimize exposure. Prolonged exposure to alcohol, like soaking the catheter in alcohol for a few days, is not recommended and long periods of exposure to alcohol can weaken the structure of the polyurethane. Ethanol lock solutions have not been tested by the manufacturer, and no specific recommendation can be made by the company. Do not use acetone on the catheter surface. Acetone may be applied to skin but must be allowed to dry completely prior to applying dressing.


Is the sterility compromised if the packaging gets wet?

If the outer cardboard packaging gets wet, the kits are not necessarily compromised. If the actual kit gets wet, then sterility is compromised. According to the manufacturer of Tyvek®, the sterility of a package is maintained and guaranteed until the package is opened or damaged. If the outside of the Tyvek® packaging becomes wet, it is considered damaged. For additional information on Tyvek®, visit www.tyvek.com.


What are the active ingredients in the ARROWg+ard® Antimicrobial Technology? What are the active ingredients in the Chlorag+ard® Antimicrobial and Antithrombogenic Technology?

ARROWg+ard Technology is a combination of chlorhexidine and silver sulfadiazine bonded to the catheter's surface. This technology is available for ARROW® CVCs, PSIs, MACs, and Acute Hemodialysis Catheters. Chlorag+ard® Technology is a chlorhexidine only technology. It is available for ARROW® PICCs and JACCs.

For more information on:

ARROWg+ard® Technology visit ARROWgard.com

Chlorag+ard® Technology visit Chlorag+ard.com

Chlorhexidine visit Chlorhexidinefacts.com


What are the recommended temperature storage conditions for ARROW® CVC products?

It is generally recommended that ARROW® products should be stored between 20 – 25°C (68 – 77°F). The kits should not be exposed to freezing temperatures at 0°C (32°F) or below nor excessive heat 40°C (104°F) or above. The temperature controls are to ensure the quality, functionality, and safety of our product. The temperature parameters are based on internal testing and individual kit items. Check your product lidstock for more information.


Do ARROW® CVC kits contains latex?

Most ARROW® products do not contain natural rubber latex. There are two ways that you can check if a product contains latex. First, this information is available on the lidstock which will be indicated by the text "latex free," "this product contains NO natural rubber latex" or it contains the word "latex" with an X through it. Second, this information is available on the online catalog at arrowvascular.com.


Do ARROW® products contain heparin?

Few ARROW® products still contain heparin. Within the Central Venous Access product family in the United States, we no longer offer heparin coated catheters due to the lack of clinical evidence, risk of thrombocytopenia and superior alternatives (see Chlorag+ard® Technology as an alternative ).

References:

  1. O'Grady et al. Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011. The Centers for Disease Control. http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf. Accessed May 16, 2011.
  2. http://www.arrowintl.com/documents/pdf/literature/2008-0114.pdf
  3. Maki et al. Prevention of Central Venous Catheter-Related Bloodstream Infection With an Antiseptic-Impregnated Catheter: A Randomized, Controlled Trial. Annals of Internal Medicine, August 15, 1997, Vol. 127, Issue 4, pp. 257–266.
  4. Rupp et al. Effect of a Second-Generation Venous Catheter Impregnated With Chlorhexidine and Silver Sulfadiazine on Central Catheter-Related Infections: A Randomized, Controlled Trial. Annals of Internal Medicine, Vol. 143, No. 8, October 18, 2005, pp. 570–581.
  5. Hidron AI et al. "Antimicrobial-Resistant Pathogens Associated With Healthcare-Associated Infections: Annual Summary of Data Reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007." Infection Control and Hospital Epidemiology 2008 Vol 29, No. 11: 996-1011
  6. Data on File
Rx only
Teleflex, AGB+, Arrow, Arrowg+ard, Blue FlexTip, Chlorag+ard, ErgoPack, HemoHopper and Never Settle are trademarks or registered trademarks of Teleflex Incorporated or its affiliates. MC-000253