MULTILUMEN CENTRAL VENOUS CATHETERS IN CHILDREN - RELATIVE POTENTIAL TO PERFORATE VESSELS - AN IN-VITRO STUDY

Objective. Because cardiovascular perforation by a central venous cath eter (CVC) is a serious complication of catheterization in pediatric p atients, 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 cath eters varied in tendency to perforate such a material and thus indicat e a ''relative potential for perforation.'' Methods. Each CVC protrudi ng from a support tube was suspended in a water-filled Plexiglas chamb er at a 90 degrees incident angle to a polyethylene film, which was ma de to bulge 6 mm into the CVC tip 120 times per minute by hydropressur e. Perforation of the polyethylene 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 polyure thane, 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 cathe ter being tested 5 times). Results, The number of pulsations to perfor ation ranged from 1 +/- 0.4 SD to > 7000. Conclusions. This in vitro s tudy of the worst-case condition (90 degrees incident angle between CV C 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 con templated in children, in addition to insertion site, catheter length, and depth of insertion, the type of catheter is another variable to c onsider in order to minimize the chance of cardiovascular perforation by the CVC tip.