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Effect of heparin-bonded pulmonary artery catheters on the activated coagulation time
S E McNulty1, D P Maguire, R E Thomas
1Department of Anesthesiology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107-5092, USA.
Insights
A heparin-bonded pulmonary artery catheter (PAC) can prolong activated coagulation time (ACT) measurements from central venous blood. Obtain baseline ACT from arterial samples to avoid anticoagulant effects from the PAC.
Area of Science:
- Cardiovascular Research
- Medical Device Evaluation
- Coagulation Science
Background:
- Pulmonary artery catheters (PACs) are used in cardiac surgery.
- Heparin bonding aims to reduce thrombogenicity.
- The effect of heparin-bonded PACs on coagulation monitoring is not fully understood.
Purpose of the Study:
- To evaluate the impact of heparin-bonded PACs on activated coagulation time (ACT).
- To compare ACT measurements from arterial and central venous blood samples post-PAC insertion.
Main Methods:
- Prospective, controlled comparison study in adult cardiac surgery patients.
- Celite ACT measured from arterial and central venous blood before and after PAC insertion.
- Thromboelastograms obtained before and 2 minutes after PAC insertion.
Main Results:
- No significant difference in ACT between sample sites before PAC insertion.
- Central venous ACT significantly increased compared to arterial ACT post-PAC insertion (2, 5, 10, 20 minutes; p < 0.005).
- 2-minute post-PAC central venous ACT exceeded 60 minutes in all cases.
Conclusions:
- Heparin-bonded PACs cause localized, time-dependent alterations in ACT.
- Baseline ACT measurements should ideally be from arterial catheters to minimize PAC anticoagulant effects.
Objective:
This study evaluated the effect of a heparin-bonded pulmonary artery catheter (PAC) on the activated coagulation time (ACT).
Design:
A prospective, controlled comparison.
Setting:
A tertiary care university hospital.
Participants:
Adult cardiac surgery patients.
Interventions:
Celite ACTs were measured from arterial and central venous blood samples before and after the insertion of a heparin-bonded PAC. Thromboelastograms were also obtained from central venous blood samples before and 2 minutes after PAC insertion.
Measurements And Main Results:
There was no significant difference between the sample sites before PAC insertion. After PAC insertion, the central venous ACTs were significantly increased compared with the corresponding arterial measurements at 2, 5, 10, and 20 minutes (p < 0.005, analysis of variance [ANOVA] for repeated measures, Fisher's protected least significant difference [PLSD]). The 2-minute post-PAC reaction time from the central venous blood sample was greater than 60 minutes in all cases.
Conclusion:
The heparin-bonded PAC was associated with a localized, time-dependent alteration in the ACT. Whenever possible, blood samples for baseline ACT measurements should be obtained from an arterial catheter to minimize the anticoagulant effects from the PAC.