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Multilumen central venous catheters in children: relative potential to perforate vessels. An in vitro study
R H Welch1, N Gravenstein, R H Blackshear
1Department of Anesthesiology, University of Florida College of Medicine, Gainesville 32610-0254, USA.
Insights
Pediatric central venous catheters (CVCs) vary in their risk of causing cardiovascular perforation. This study found significant differences in perforation potential among CVC types, suggesting catheter choice is crucial for patient safety.
Area of Science:
- Medical Devices
- Pediatric Cardiology
- Biomaterials
Background:
- Cardiovascular perforation is a serious complication of central venous catheter (CVC) use in children.
- Assessing the risk of perforation from different CVC designs is critical for pediatric patient safety.
Purpose of the Study:
- To evaluate the relative potential for perforation of a standard material by the tips of various multilumen pediatric central venous catheters (CVCs) in an in vitro setting.
- To determine if different CVC materials and designs exhibit varying tendencies to perforate under simulated conditions.
Main Methods:
- An in vitro model was developed using a polyethylene film to simulate vessel tissue.
- Central venous catheters (CVCs) were positioned at a 90-degree angle to the film and subjected to pulsatile hydropressure.
- The number of pulsations required to perforate the film was recorded for different types of 4- and 5-Fr multilumen pediatric CVCs.
Main Results:
- A wide range in the number of pulsations to perforation was observed, from 1 +/- 0.4 SD to over 7000.
- This indicates significant variability in the perforation potential among the tested pediatric CVCs.
Conclusions:
- Pediatric multilumen CVCs demonstrate a significant difference in their potential to perforate a standard material under worst-case conditions.
- Catheter type should be considered alongside insertion site, length, and depth to minimize the risk of cardiovascular perforation during central venous catheterization in children.
Objective:
Because cardiovascular perforation by a central venous catheter (CVC) is a serious complication of catheterization in pediatric patients, we conducted an in vitro study of the relative potential for perforation of a standard material by the tips of multilumen pediatric catheters. Since we could not simulate vessel tissue, we hypothesized that testing catheters on a standard material would show whether catheters varied in tendency to perforate such a material and thus indicate a "relative potential for perforation."
Methods:
Each CVC protruding from a support tube was suspended in a water-filled Plexiglas chamber at a 90 degrees incident angle to a polyethylene film, which was made to bulge 6 mm into the CVC tip 120 times per minute by hydropressure. Perforation of the polyetheylene film was documented on a time-based, strip-chart recording of pressure change on the opposite side of the film. We recorded the number of pulsations required for the following catheters to perforate the polyethylene: Arrow flex tip, Cook polyurethane, Viggo hydrocath polyurethane, and Cook silicone CVCs of 4- and 5-Fr size with 2 or 3 lumens (n = 5 catheters of each type, each catheter being tested 5 times).
Results:
The number of pulsations to perforation ranged from 1 +/- 0.4 SD to > 7000.
Conclusions:
This in vitro study of the worst-case condition (90 degrees incident angle between CVC tip and polyethylene film) indicates that pediatric multilumen CVCs vary significantly in their relative potential to perforate a standard material. We suggest that, when central venous catheterization is contemplated in children, in addition to insertion site, catheter length, and depth of insertion, the type of catheter is another variable to consider in order to minimize the chance of cardiovascular perforation by the CVC tip.