title: An evaluation of commonly employed central venous catheter kits and their potential risk for complications of excess guidewire introduction.
abstract: OBJECTIVE
  To evaluate the components of commonly used central venous catheter kits with respect to the potential for guidewire-mediated complications during catheter placement.Prospective, nonrandomized, observational study.
  
  
  METHODS
  Six academic hospitals across the United States.
  
  
  METHODS
  None.
  
  
  METHODS
  None.
  
  
  RESULTS
  30 commercially manufactured catheter kits (15 tunneled, 15 nontunneled) were opened and evaluated. The catheter or sheath to be introduced was measured and a corresponding ideal guidewire length was calculated. The ideal length was then compared to the actual length, and differences were tabulated. Wire tip configuration and the presence and pattern of distance markings were recorded and, in conjunction with the catheter and wire length discrepancies, were used to grade the relative risk of introducing excess guidewire during catheter placement. Of 30 kits evaluated, 14 (46.7%) had guidewires more than 20 cm longer than necessary. The mean excess wire length was 15 cm (range: 8 to 55 cm) and did not differ significantly between tunneled and nontunneled catheter kits. Only 10 kits (33.3%) had distance markings of any type, and there was no standardization among them; none corresponded to previously published recommendations. There was potential risk of excess wire introduction in 18 catheter kits, of which seven were nontunneled devices designed for bedside placement.
  
  
  CONCLUSIONS
  The design of commonly employed central venous access catheter kits is such that there is a mismatch between guidewire and catheter length and a general lack of guidewire markings. We believe that these designs may predispose to the introduction of excess guidewire and result in guidewire-mediated complications during catheter placement. This risk can likely be reduced by matching the guidewires to the devices placed over them and by standardizing guidewire distance markings.
authors.affiliation: Dotter Interventional Institute, Oregon Health & Science University, Portland, USA.
authors.forename: Justin B
authors.initials: JB
authors.lastname: Rufener
authors.forename: Robert T
authors.initials: RT
authors.lastname: Andrews
authors.forename: Michael E
authors.initials: ME
authors.lastname: Pfister
authors.forename: Lawrence V
authors.initials: LV
authors.lastname: Hofmann
authors.forename: Robert D
authors.initials: RD
authors.lastname: Bloch
authors.forename: Bruce T
authors.initials: BT
authors.lastname: Kudryk
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Venbrux
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation* / Q000592:standards; D004867:Equipment Design; D019544:Equipment Failure Analysis; D006801:Humans; D011446:Prospective Studies; D012107:Research Design; D012307:Risk Factors