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Quantitative analysis of catheter roughness induced by cutting and manipulation: a potential prothrombotic risk
Anusha Jegatheeswaran1, Nagina Parmar, J Mark Walton
1Division of Pediatric Surgery, McMaster Children's Hospital, Hamilton, Ontario, Canada.
Insights
Cutting central venous access device catheters can increase thrombosis risk by creating rough surfaces. Scalpel cutting and minimal handling produce the smoothest catheter tips, reducing potential complications.
Area of Science:
- Medical Devices
- Materials Science
- Vascular Surgery
Background:
- Thrombosis is a significant complication associated with central venous access devices (CVADs).
- The surface characteristics of CVAD tips, including roughness, can influence thrombus formation.
- Catheter modification, such as cutting to length, may alter tip surface integrity.
Purpose of the Study:
- To evaluate the surface roughness of manufactured catheter tips compared to those cut and handled.
- To determine the impact of different cutting instruments and handling tools on catheter tip surface quality.
Main Methods:
- Three types of central venous catheters were analyzed: Hickman, Port-a-Cath, and Per Q Cath.
- Catheter tips were cut using scissors, iris scissors, or a scalpel, and handled with various forceps and needle drivers.
- Scanning electron microscopy (SEM) and atomic force microscopy (AFM) were employed to assess surface roughness and damage.
Main Results:
- Scalpel-cut and manufactured catheter tips exhibited smoother surfaces compared to those cut with scissors or iris scissors.
- Handling with debakey forceps and adson forceps with teeth caused significant surface damage, including deep holes and grainy textures.
- Adson forceps without teeth resulted in the least amount of surface damage during handling.
Conclusions:
- Minimizing catheter handling and avoiding certain instruments like adson forceps with teeth are crucial to prevent surface damage.
- Scalpel cutting offers a smoother finish than scissors, potentially reducing thrombosis risk.
- Optimizing catheter preparation techniques is essential for improving the safety and efficacy of central venous access devices.
Abstract:
Thrombosis is a major complication of central venous access devices, its incidence depending on material, diameter, tip position, and tip surface. Catheters are usually cut to the appropriate length for accurate positioning. Cutting is not recommended, however, as rough surfaces can serve as a nidus for thrombosis. The present study was performed to assess the roughness of catheter tips provided by various manufacturers versus the roughness once cut and handled. Three types of catheters (Hickman, Port-a-Cath, and Per Q Cath) were cut by scissors, iris scissors, or scalpel, and were handled with debakey forceps, a needle driver, adson with teeth or adson without teeth, to determine the damage created on the catheter. The uncut manufactured tip was compared as a control. Scanning electron microscopy was used for imaging of all samples, and roughness was quantified by atomic force microscopy for the cutting methods. Qualitative results by scanning electron microscopy showed that scalpel-cut and manufactured ends appeared smoother relative to those cut with scissors or iris scissors. This complemented the roughness analysis by atomic force microscopy. Catheters handled by debakey forceps and adsons with teeth showed most roughness, visible as deep holes or a grainy surface when observed by high-magnification scanning electron microscopy. Overall, the smoothest result was produced by scalpel, followed by the manufactured end, scissors, and iris scissors. Handling should be minimized, and use of adsons with teeth, needle drivers and debakey forceps should be avoided, as they can leave permanent damage. Adsons without teeth appeared the least damaging.
