The intravenous infusion has become indispensable in modern medical therapy, but infection, especially infusion-associated septicemia, remains a life-threatening hazard. In 1970 to 1971 a ...

Infection Control in Intravenous Therapy.

A nationwide survey was undertaken to determine the rate of complications due to coronary arteriography during 1970-71. The responses from 173 hospitals-including a total of 46,904 coronary arteriograms-were analyzed in relationship to the technique employed and to the number of examinations performed at each hospital during the two-year period. The overall mortality rate was 0.45% (brachial 0.13%, femoral 0.78%). The mortality rate in institutions performing fewer than 200 examinations per two years was eight times higher than in institutions performing more than 800 examinations per two years. Similarly, the incidence of myocardial infarction and cerebral embolism was significantly higher when a smaller number of examinations was performed. The incidence of major complications-including death, myocardial infarction, and cerebral embolism-was higher in examinations using the femoral approach than the brachial approach. The incidence of arterial thrombosis and contrast agent reactions was higher for the b...

The Complications of Coronary Arteriography

Deposition of thrombotic material on catheters was observed following more than 50% of 93 diagnostic catheterizations. The incidence of deposition of thrombotic material on catheters remaining in the body for more than 1 day was 100%. Polyethylene and siliconized polyurethane catheters were less thrombogenic than Teflon end-occluded catheters. A definite time relationship between the thrombus formation and the duration of the catheterization procedure was noted. The growth of thrombi on the outside of catheters does not appear to be linear since catheters can remain in place for 10 days or more. Postcatheterization thrombosis is believed to be due to thrombi stripped from the catheter by the arterial wall. The thrombus which originally encases the catheter will pile up at the puncture site as the catheter is withdrawn. The thrombus may remain attached at the puncture site or embolize peripherally.

Arterial Thrombus Formation During Clinical Percutaneous Catheterization

Thrombosis at the site of arterial puncture is a common and serious complication of percutaneous cardiac catheterization in children. A double-blind study was therefore designed to test the efficacy of heparin administered during catheterization in reducing this complication. One hundred and sixty-one unselected children over one year of age were studied. Prior to catheterization, the pulse amplitudes were measured in both legs using a Pulse Volume Recorder (a standardized oscillometer). Immediately after arterial cannulation, heparin, 1 mg/kg, or a placebo was administered. On the morning following catheterization, the pulse amplitude in both legs was remeasured and a pulse volume index calculated using the uncatheterized leg as a control. Patients in whom the catheterized leg was cold, with poor capillary filling and absent arterial pulses four hours after the completion of catheterization, were started on intravenous infusion of heparin. If no improvement occurred within 48 hours, embolectomy was perfo...

The Use of Heparinization to Prevent Arterial Thrombosis after Percutaneous Cardiac Catheterization In Children

Percutaneous central arterial catheterizations were performed at the first radial-artery site in 492 (92 per cent) of 536 insertion attempts in patients in an intensive-care unit. The high success rate was attributed to placement by skilled nurse technicians and use of a simplified catheter device. The mean duration of catheterization was 3.4 days (range, one to 25 days). With use of a continuous flush system, only five catheters became nonfunctional. Hypotension, use of vasoconstrictive agents and prolonged catheterization were associated with complete arterial occlusion in three study patients who required thrombectomies. Partial occlusions, detected by Doppler ultrasonic flowmeter, occurred in 19.3 per cent. No local or systemic infections could be definitely related to arterial catheters. Results of 200 arterial catheter-tip cultures were positive in eight cases (4 per cent), but none of these were judged to be a primary source of clinical infection. (N Engl J Med 290:1227–1231, 1974)

https://www.nejm.org/doi/pdf/10.1056/NEJM197405302902205?listPDF=true

Percutaneous indwelling radial-artery catheters for monitoring cardiovascular function. Prospective study of the risk of thrombosis and infection

Thrombotic and embolic accidents are serious complications of vascular catheterizations Some of these complications are caused by the stripping of clot from the surface of the catheters as these catheters are withdrawn through the holes in the vascular walls (Fig 1) The purpose of this work was to investigate the rate of clotting on the surface of various catheters and to find possible means of prevention The catheters studied were those commonly employed in clinical catheterization, namely nonradiopaque polyethylene, nonradiopaque Teflon, radiopaque polyethylene of Swedish manufacture, radiopaque polyethylene of American manufacture, radiopaque Teflon, woven Rodriguez Alvarez coated with a “special compound,” woven directable Cordis catheters (probably covered with polyurethane), and Silastic medical grade tubing All catheters were No 7 French Technic Under general anesthesia, the carotids and the jugular veins of large dogs were isolated as far as possible toward the head and toward the chest On

C. Gianturco

Papers

Clotting on the outer surfaces of vascular catheters.