Welch R H, Gravenstein N, Blackshear R H
Department of Anesthesiology, University of Florida College of Medicine, Gainesville 32610-0254, USA.
J Clin Monit. 1997 Mar;13(2):75-9. doi: 10.1023/a:1007389228641.
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."
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).
The number of pulsations to perforation ranged from 1 +/- 0.4 SD to > 7000.
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.
由于中心静脉导管（CVC）导致的心血管穿孔是儿科患者插管的严重并发症，我们进行了一项体外研究，以探讨多腔儿科导管尖端穿透标准材料的相对可能性。由于无法模拟血管组织，我们假设在标准材料上测试导管将显示导管在穿透这种材料的倾向上是否存在差异，从而表明“相对穿孔可能性”。
将从支撑管伸出的每根CVC以90度入射角悬挂在充满水的有机玻璃腔室中，与聚乙烯膜相对，通过水压使聚乙烯膜每分钟向CVC尖端内凸出6毫米120次。在基于时间的薄膜另一侧压力变化的带状图表记录上记录聚乙烯膜的穿孔情况。我们记录了以下导管穿透聚乙烯所需的搏动次数：Arrow flex tip导管、Cook聚氨酯导管、Viggo hydrocath聚氨酯导管以及4F和5F尺寸、2或3腔的Cook硅胶CVC（每种类型n = 5根导管，每根导管测试5次）。
穿孔所需的搏动次数范围为1±0.4标准差至>7000次。
这项在最坏情况条件下（CVC尖端与聚乙烯膜之间呈90度入射角）的体外研究表明，儿科多腔CVC在穿透标准材料的相对可能性方面存在显著差异。我们建议，在考虑对儿童进行中心静脉插管时，除了插入部位、导管长度和插入深度外，导管类型是另一个需要考虑的变量，以尽量减少CVC尖端导致心血管穿孔的机会。
