In vitro comparison of central venous catheters for aspiration of venous air embolism: Effect of catheter type, catheter tip position, and cardiac inclination

Abstract

Study Objective: To test the relative efficiency of balloon-tipped and plain catheters for aspiration of venous air embolism. Design: The following four single-lumen central venous catheters were studied in a silastic model of the right atrium, tricuspid valve, and vena cavae: (1) the 16-gauge single-orifice catheter; (2) the 14-gauge Bunegin-Albin multiori(ice catheter; (3) the 7-Fr pulmonary angiography catheter with balloon distal to orifices; (4) the 7-Fr pulmonary angiography catheter with balloon proximal to orifices. A 10% glycerol-water solution was circulated at 3.7 to 4.0 L/min. Catheter tips were positioned at 1 cm increments from −3 to +3 cm around the superior vena cavaright atrial junction with cardiac inclinations of 65° and 80°. Air (10 ml) was infused over 30 seconds; aspiration from the test catheter began 5 seconds later at 40 ml/min for 75 seconds. The balloon catheters were evaluated with the balloons inflated and deflated. Setting: Experimental laboratory of a university-affiliated hospital. Measurements and Main Results: Amounts ofi air aspirated were compared by analysis of variance and Tukey's multiple comparison, p < 0.05, for all combinations. The 16-gauge single-orifice catheter tested best at a 65° cardiac inclination with 86% of the venous air embolism recovered, while the 14-gauge Bunegin-Albin multiorifice catheter tested best at an 80° cardiac inclination with 62% of the venous air embolism recovered. Both catheters functioned most efficiently at or above the superior vena cava-right atrial junction. Conclusions: This study demonstrated that efficacy of air recovery depends on catheter type, catheter tip position, and cardiac inclination. No benefit was derived from positioning the catheter tip inside the atrium or from using balloon-tipped catheters.