THE APPLICATION OF A PRESSURIZED INFUSOR TO ARTERIOGRAPHY.

Abstract

One of the potentially troublesome aspects of arteriography is the possibility of clot formation in any of the various types of needles or catheters employed. The primary method of preventing such an occurrence has been the intermittent manual flushing of the needles or catheters with the standard glass syringes. The possibility always exists, however, that a clot may form at the very tip of the needle or catheter between each flushing. The propagation of a clot of any size can be deleterious, particularly in the performance of cerebral angiography. Also, needles cannot be flushed intermittently without a certain amount of movement which may be disadvantageous, especially after a difficult puncture of the common carotid artery. We are now using a pressurized infusor which (a) provides a continuous flow of flushing media through either a needle or catheter to prevent any clot formation, and (b) reduces the amount of movement of the needle which would ordinarily occur with the usual manual flushing technic. We have had experience in more than 100 cases studied by cerebral arteriography via the common carotid and right brachial artery routes, and other cases in which abdominal aortography and renal arteriography have been performed via the retrograde femoral artery route. No complications whatsoever have resulted with this arrangement. Our surgical and neurosurgical colleagues have been assured of a certain sense of well-being, knowing that as long as the pressurized drip is running, there is virtually no chance for any clot to form within either needle or catheter. The various parts of the complete infusor arrangement are illustrated and explained in Figure 1. The disposable administration set is filled with 500 cc of normal saline. We do not feel that heparin is necessary in the infusion. After making sure that all the air is out of the administration set connector tubing and the large pouch of the disposable administration set itself, the tubing is clamped both above and below the large pouch. The pouch itself is then inserted underneath the mesh of the pressure infusor with the large inlet tube pointing upward and the longer and thinner connecting tubing pointing downward. The unit is hung on an intravenous pole, and the pressure is increased to approximately 150 mm of mercury. The clamp is released on the connector tubing, so as to produce a good flow of saline and eliminate any possible remaining air bubbles. At this point, the needle or catheter is placed in the appropriate artery. The 3-way wide-bore Pilling stopcock is attached directly to the catheter or to a 16 in. Pilling tubing which in turn is connected to a Marshall needle as, for example, in performing carotid arteriography via the right brachial or common carotid route.