Central venous catheter failure is induced by injury and can be prevented by stabilizing the catheter tip Ted R. Kohler, MD, Thomas R. Kirkman, BS Journal.

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Presentation transcript:

Central venous catheter failure is induced by injury and can be prevented by stabilizing the catheter tip Ted R. Kohler, MD, Thomas R. Kirkman, BS Journal of Vascular Surgery Volume 28, Issue 1, Pages 59-66 (July 1998) DOI: 10.1016/S0741-5214(98)70200-9 Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Schematic diagram of the design of the loop catheter. Journal of Vascular Surgery 1998 28, 59-66DOI: (10.1016/S0741-5214(98)70200-9) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Diagram of position of control (A) and test catheters (B). Catheters enter via right external jugular vein and are positioned with the tip just above junction with superior vena cava. Histologic sections are taken at the level of catheter tip (I) and along the catheter at a distance of 0.5 cm (II) and 1.0 cm (III). An additional section was taken at the region of greatest wall thickening if this was not included in I, II, or III. Motion of tip of control catheter is indicated by dotted lines. EJ, External jugular vein; IJ, internal jugular vein; AX, axillary vein; SVC, superior vena cava. Journal of Vascular Surgery 1998 28, 59-66DOI: (10.1016/S0741-5214(98)70200-9) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Scanning electron micrograph of region of endothelial damage in superior vena cava caused by catheter tip (original magnification ×200). Journal of Vascular Surgery 1998 28, 59-66DOI: (10.1016/S0741-5214(98)70200-9) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Photograph of 2-week specimen with catheter in place. Large mural thrombus lies in distal superior vena cava, extending into right atrium. Fresh thrombus is present on surface. Arrowhead marks caval-atrial junction. Journal of Vascular Surgery 1998 28, 59-66DOI: (10.1016/S0741-5214(98)70200-9) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Macrophages adjacent to new capillary in lesion from 1-week control animal. Arrowhead marks a multinucleated giant cell. (original magnification ×184, hematoxylin and eosin stain). Journal of Vascular Surgery 1998 28, 59-66DOI: (10.1016/S0741-5214(98)70200-9) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Gross photograph of lesion at catheter tip in 8-week control animal. Superior vena cava has been opened, and in the process the catheter tip was dislodged from the lesion in which it had been completely embedded. Cast of catheter tip can be seen in distal portion of lesion (open arrow). The tip of the catheter remains covered with fibrotic tissue. Arrowhead marks caval-atrial junction. Journal of Vascular Surgery 1998 28, 59-66DOI: (10.1016/S0741-5214(98)70200-9) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Gross photograph of a loop catheter at 8 weeks. Catheter tip is completely free in the lumen, and there is no gross evidence of vessel injury. Arrowhead marks caval-atrial junction. Journal of Vascular Surgery 1998 28, 59-66DOI: (10.1016/S0741-5214(98)70200-9) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions