Abstract
Perforation of the vena cava or atrium is a serious complication of monitoring with a central venous catheter. We designed an in vitro model with a pulsating simulated membrane to evaluate a number of variables that could affect relative perforating potential of different types of central venous catheters. To determine the perforating potential of central venous catheters, we studied the effects of (1) the angle of incidence (n=6) between catheter and simulated membrane; (2) catheter material (polyurethane and polyethylene); (3) make (manufacturer and model) (n=6), with 3 catheters of each make tested; (4) design (n=3 each: silicone rubber, open-ended, blunt-ended, and polyurethane pigtail); and (5) number of lumens (single, double, or triple). Each trial was repeated five times with each catheter that was tested. Perforation was significantly more likely when the angle of incidence between catheter and pulsating simulated membrane was greater than 40° than when it was 40° (P<0.05). Perforation was less likely with single-lumen than comparable Frenchsized double- and triple-lumen catheters; among single-lumen catheters, perforation required many more pulsations with a polyurethane than a polyethylene catheter (P<0.001). Perforation potential differed significantly among 6 makes of 7-French triple-lumen catheters (P<0.05). Compared with other materials or designs, silicone rubber or a pigtail tip decreased the perforation potential of catheters (P<0.001). These data offer additional objective information to consider when choosing and positioning central venous catheters.
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Presented in part at the Eighth Medical Monitoring Technology Conference, Vail, CO, March 1988; the Ninth World Congress of Anaesthesiologists, Washington, DC, May 1988; and the annual meeting of the American Society of Anesthesiologists, San Francisco, CA, October 1988.
We thank Cook Critical Care (Division of Cook, Inc) for supporting this project from its inception and Christine R. Finnegan and Lynn Dirk for editorial help in preparation of this manuscript.
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Gravenstein, N., Blackshear, R.H. In vitro evaluation of relative perforating potential of central venous catheters: Comparison of materials, selected models, number of lumens, and angles of incidence to simulated membrane. J Clin Monitor Comput 7, 1–6 (1991). https://doi.org/10.1007/BF01617891
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DOI: https://doi.org/10.1007/BF01617891