The relationship of central venous and pulmonary artery catheter position to acute right-sided endocarditis in severe thermal injury.

Abstract

Autopsies of 1,105 burned patients completed from January 1951 through March 1977 were reviewed at the United States Army Institute of Surgical Research to investigate the relationship between central venous and pulmonary artery cannula use and the incidence of endocarditis. The incidence of endocarditis increased from 3.4 to 9.4% after 1969 when cardiac injury attributed to central venous cannula use was first noticed at autopsy. Since 1969, right heart nonbacterial and bacterial endocarditis has dramatically increased and the right heart has become the prevalent site of the cardiac lesions. Review of premortem chest roentgenograms from 14 recent autopsy cases with right heart endocardial injury confirmed that central venous catheter tips were placed in the vicinity of the right atrium or right ventricle in 86% of the cases. Pathogenetically, the majority of the infected right heart lesions are probably the result of cannula-induced injury, with subsequent thrombosis and later bacterial colonization during episodes of bacteremia which are common in burned patients.