Subcutaneous, catheter-related inflammation in a rabbit model correlates with peripheral vein phlebitis in human volunteers.
In the development of a polyurethane vascular catheter with anti-infective properties, it became desirable to develop a measure of tissue inflammation. This was investigated in a rabbit model by implanting uncoated catheters and catheters coated with heparin (HEP), chlorhexidine (CH), or CH/HEP in the subcutaneous space with or without 10(4) Staphylococcus aureus. At intervals of 2, 4, and 7 days after implantation, animals were sacrificed; tissue blocks containing catheters were removed and preserved with formaldehyde; and sections were stained with hematoxylin and eosin. Using a histologic index, 240 sections (10 for each experimental condition) were evaluated by two investigators blinded to experimental conditions. Uncoated catheters or catheters coated with CH alone had a lower histologic index (less inflammation) than catheters coated with HEP alone or CH/HEP (P < .05). When catheters were inoculated with S. aureus, those coated with CH, with or without HEP, had a lower histologic index than uncoated catheters (P < .05). Next, 30 volunteers had a control catheter inserted in a vein in one forearm and a catheter coated with either CH alone or CH/HEP in a vein in the other forearm. After 96 h of observation there was a greater risk of phlebitis associated with CH/HEP catheters than control catheters (P < .05), and no difference in the risk of phlebitis between CH catheters and control catheters (P = 0.43). Thus, the amount of inflammation around the catheter in the subcutaneous space of rabbit correlated with the risk of peripheral vein phlebitis.
Carruth
W A
WA
Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1042.
Byron
M P
MP
Solomon
D D
DD
White
W L
WL
Stoddard
G J
GJ
Marosok
R D
RD
Sherertz
R J
RJ
D000328:Adult; D000818:Animals; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002710:Chlorhexidine / Q000009:adverse effects / Q000627:therapeutic use*; D004195:Disease Models, Animal; D004311:Double-Blind Method; D006801:Humans; D010689:Phlebitis / Q000453:epidemiology / Q000209:etiology*; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000517:prevention & control*; D011817:Rabbits; D012307:Risk Factors
D002710:Chlorhexidine