In vitro evaluation of relative perforating potential of central venous catheters: comparison of materials, selected models, number of lumens, and angles of incidence to simulated membrane.

Perforation of the vena cava or atrium is a serious complication of monitoring with a central venous catheter. We designed an in vitro model with a pulsating simulated membrane to evaluate a number of variables that could affect relative perforating potential of different types of central venous catheters. To determine the perforating potential of central venous catheters, we studied the effects of (1) the angle of incidence (n = 6) between catheter and simulated membrane; (2) catheter material (polyurethane and polyethylene); (3) make (manufacturer and model) (n = 6), with 3 catheters of each make tested; (4) design (n = 3 each: silicone rubber, open-ended, blunt-ended, and polyurethane pigtail); and (5) number of lumens (single, double, or triple). Each trial was repeated five times with each catheter that was tested. Perforation was significantly more likely when the angle of incidence between catheter and pulsating simulated membrane was greater than 40 degrees than when it was 40 degrees (P less than 0.05). Perforation was less likely with single-lumen than comparable French-sized double- and triple-lumen catheters; among single-lumen catheters, perforation required many more pulsations with a polyurethane than a polyethylene catheter (P less than 0.001). Perforation potential differed significantly among 6 makes of 7-French triple-lumen catheters (P less than 0.05). Compared with other materials or designs, silicone rubber or a pigtail tip decreased the perforation potential of catheters (P less than 0.001). These data offer additional objective information to consider when choosing and positioning central venous catheters.