title: Multilumen central venous catheters in children: relative potential to perforate vessels. An in vitro study.
abstract: 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.
authors.affiliation: Department of Anesthesiology, University of Florida College of Medicine, Gainesville 32610-0254, USA.
authors.forename: R H
authors.initials: RH
authors.lastname: Welch
authors.forename: N
authors.initials: N
authors.lastname: Gravenstein
authors.forename: R H
authors.initials: RH
authors.lastname: Blackshear
mesh_terms: D001808:Blood Vessels / Q000293:injuries*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002648:Child; D004867:Equipment Design; D006801:Humans; D008961:Models, Structural; D014950:Wounds, Penetrating / Q000209:etiology*