Detection of endotoxin on sterile catheters used for cardiac catheterization

Pyrogen reactions during cardiac catheterization are an alarming complication that frightens patients and baffles many physicans. This report describes a simple, reproducible, precise technique for the measurement of endotoxin-like activity on the inner and outer surfaces of catheters intended for intravascular insertion. This technique is useful in documenting the cause of patient reactions. Quality control procedures should be instituted following the manufacture of angiographic catheters so that pyrogen-free products are availabe for patient use. Catheters processed in a hospital are easily contaminated with fever-producing lipopolysaccharides from tap water or from bacterial growth in residual moisture. Sterilization by steam or ethylene oxide does not destroy these lipopolysaccharides. Consequently, reprocessing reusable catheters must include concern for removing lipopolysaccharides as well as sterilization.