Catheter Gauge Research Articles

Catheter Insertion for Intravenous (IV) Contrast Infusion in Multidetector-Row Computed Tomography (MDCT)

This study evaluated the effect of intravenous (IV) catheter gauge size on catheter placement, contrast infusion, and image quality for patients undergoing IV contrast-enhanced multidetector computed tomography (MDCT). One thousand consecutive adult outpatients undergoing IV contrast-enhanced MDCT and 10 IV insertion CT nurses were observed from IV catheter selection through IV removal. Patients' demographics, number of sticks required, catheter gauge during each attempt, time for catheter placement, IV nurses' assessment of vein quality and contrast infusion parameters were recorded. Scan quality was assessed subjectively. Subjects included 547 men and 453 women, with a mean age 59.2 years (range, 19-92 years). Median number of catheter attempts was 1 per patient (range, 1-9). Catheters were successfully placed in 98%. First and final catheters were most commonly 20 gauge (59% and 56%, respectively), followed by 22 gauge (34% for both), 18 gauge (6% for both), and 24 gauge (2% and 3%, respectively). Mean infusion rate correlated with catheter gauge: 5.3 mL/s for 18 gauge; 3.5 mL/s for 20 gauge; 2.3 mL/s for 22 gauge; and 1.7 mL/s for 24 gauge (P < 0.0001). Target infusion rate of ≥ 3 mL/s was related to catheter gauge (100% of 18 gauge, 71% of 20 gauge, 11% of 22 gauge, and 0% of 24 gauge; P < 0.0001). Nine hundred sixty-eight subjects underwent imaging. Most of the CT examinations (935/968 [97%]) were of acceptable quality. Experienced IV starters usually achieve IV access in one attempt by tailoring IV catheter gauge to vein quality; however, target infusion rates are not likely to be achieved with 22- and 24-gauge catheters, used in nearly 1/3 of the patients in this study.

Frequency, Management, and Outcome of Extravasation of Nonionic Iodinated Contrast Medium in 69 657 Intravenous Injections

To determine retrospectively the frequency, management, and outcomes of extravasations of intravenously injected nonionic iodinated contrast medium. Institutional review board approval was obtained, and the requirement for informed consent was waived. The study was HIPAA compliant. For 69,657 intravenous injections of nonionic iodinated contrast medium for computed tomographic examinations between January 1, 2000, and March 31, 2005, the incident reports, radiology reports, and medical records of patients in whom contrast medium extravasations occurred were reviewed. Data collected included patient age, catheter gauge, injection site, volume extravasated, patient symptoms, severity of injury, treatment, whether or not the plastic surgery service was consulted and any additional treatment that service instituted, and patient outcome. Extravasations occurred in 475 (0.7%) of 69 657 patients, and follow-up information was available for 442 adults (280 women, 162 men; mean age, 57 years) and 17 children (nine girls, eight boys; mean age, 6 years). Extravasated volumes ranged from 3 to 150 mL. Symptoms usually consisted of swelling and/or pain. The plastic surgery service was consulted for 38 adults and six children and provided additional treatment in eight patients (seven adults, one child). Among adults, 432 had minimal or no adverse effects, nine had moderate adverse effects, and one had a severe complication (75 mL of contrast material extravasated into the hand, causing compartment syndrome). Only one moderate or severe complication in an adult resulted from an extravasation of less than 50 mL. Fifteen children had minimal or no adverse effects, one had moderate adverse effects, and one had a severe complication (18 mL of contrast material extravasated into the arm, causing brachial plexopathy). Extravasation of nonionic iodinated contrast medium results only rarely in moderate or severe adverse effects, and these usually occur only when large volumes of contrast medium are involved.

Pain perception among Emergency Department patients with headache: Responses to standardized painful stimuli

Perception of pain varies significantly across groups of patients. The primary objective of this study was to measure perceived pain among Emergency Department (ED) patients with headache in response to standardized painful stimuli, including blood pressure (BP) cuff inflation and intravenous catheterization (IVC). In this prospective, case-control series, ED patients undergoing IVC and with a headache were compared to those undergoing IVC but without a headache. Medical care of participants was not altered. Data were collected by trained research assistants, including demographic and historical characteristics, and perceived pain scores. Using a 10-point verbal numeric rating scale (0 = no pain … 10 = worst imaginable pain), participants rated their perceived pain of BP measurement and IVC. Ninety-five percent confidence intervals (CI) constructed around means and proportions were used to assess group differences. One hundred participants had headache; 100 participants with no headache served as controls. There were no differences between groups with regard to gender, ethnicity, or insurance status. Intravenous catheterization was successful in all 200 participants, with a median intravenous catheter gauge of 20 (range 18–24). There were no differences between groups in difficulty of insertion of intravenous catheter or number of intravenous catheterization attempts. Participants with headache reported significantly higher pain scores from BP cuff inflation (mean score 2.9) compared to participants without headache (mean 1.4; mean difference between groups 1.5, 95% CI 0.7–2.3). Participants with headache reported slightly higher pain scores from IVC (mean 4.6) compared to participants without headache (mean 3.9; mean difference between groups 0.7, 95% CI −0.2–1.6), but this difference was not significant. Among participants with headache, there were no statistically significant differences between single headache, acute headache (<10 /past 30 days ), and chronic headache (≥10/past 30 days ) for reported pain scores of BP cuff inflation or IVC . ED participants with headache reported significantly higher pain scores secondary to BP cuff inflation when compared to control participants without headache.

Cognitive-Behavioral Interventions for IV Insertion Pain

INSERTION OF AN IV CATHETER is a commonly performed and painful procedure. The use of cognitive-behavioral interventions (CBIs) may decrease pain by diverting the patient's attention to stimuli other than pain. THIS RANDOMIZED, CONTROLLED TRIAL examined the effect of three CBIs--music, kaleidoscope, and guided imagery--on IV insertion pain in 324 patients. NO STATISTICALLY SIGNIFICANT differences in IV insertion pain were found among the treatment and control groups or between choosing versus being assigned a CBI. Insertion attempts were more difficult in women, and insertion difficulty was correlated with pain intensity and pain distress. Pain intensity was related to insertion site and catheter gauge.

Hemorrhagic Complications Of External Ventricular Drainage

Despite the widespread use of external ventricular drainage (EVD), the frequency of associated hemorrhagic complications remains unclear. This retrospective study examined the frequency of hemorrhagic complications of EVD and attempted to discern associated risk factors. Treatment records from 160 patients admitted during a 2.5-year period who required EVD placement were reviewed. Indications for placement of EVD included acute complications of cerebrovascular disease (n = 94), traumatic brain injury (n = 36), primary hydrocephalus (n = 16), and tumor (n = 14). Patients received either a 3.0 or 2.5-mm outer diameter ventricular catheter (n = 82 and 78, respectively). Postinsertion computed tomographic scans were obtained within 24 hours on all patients and were analyzed for any new hemorrhage related to the ventricular catheter. Patient age, sex, catheter type, and dimensions of hemorrhage were also analyzed. The incidence of EVD-related hemorrhage was 33 +/- 0.04%. However, the incidence of detectable change in the clinical neurological examination was 2.5%. A significant proportion of EVD-related hemorrhages were small (<4 cm), punctate, intraparenchymal hematomas. Patients with cerebrovascular disease exhibited an increased incidence (39%) of hemorrhage. The mean volume of intraparenchymal hemorrhage was larger in patients who received the 2.5-mm ventricular catheter, as well as those admitted for cerebrovascular disease. Hemorrhagic complications of EVD placement are more common than previously suspected. Admitting diagnosis seems to have an effect on the development of an associated hemorrhage and its size. Catheter gauge has an effect on hematoma volume. Most of the hemorrhages seen on postinsertion computed tomographic scans do not cause detectable changes in the clinical examination.

Transradial coronary angiography in patients with contraindications to the femoral approach: an analysis of 500 cases.

The transradial approach to coronary angiography is considered by some to be a route of choice, by others to be a route that should be used only where there are relative contraindications to the femoral approach. We present the largest series to date of patients in whom transradial coronary angiography was undertaken specifically because of contraindications to the femoral approach. Since 1995, patients at this cardiothoracic center have been considered for a transradial approach to coronary angiography if there were relative contraindications to the femoral route. Data from 500 patients was prospectively collected. Patients were aged 66 +/- 9 years; 72% were male. Indications for the radial approach included peripheral vascular disease (305), therapeutic anticoagulation (77), musculoskeletal (59), and morbid obesity (32). Sixty-eight patients (14%) required a radial procedure following a failed femoral approach. Access was right radial 291 (58%), left radial 209 (42%). Eighteen operators were involved, but two operators undertook 355 (71%) of the cases. Catheter gauge was 6 Fr (n = 243; 49%), 5 Fr (219; 43%), and 4 Fr (29; 6%). The procedure was successful in 463 cases [92.6%; 88.2% for nonmajority vs. 94.4% (P < 0.05) for the two majority operators]. Success in males (93.6%) significantly exceeded that in females (90.1%; P < 0.05). In-catheter-laboratory duration was 45 +/- 17 min; fluoroscopy time, 7.5 +/- 6 min; radiation dose, 40 +/- 23 CGy. The procedure was without incident in 408 cases (82%). There were procedural difficulties in 18% of cases, including radial artery spasm (12%) and vasovagal response (5%). The incidence was higher with 6 Fr catheters (23%) than with 5/4 Fr (15%; P < 0.05). Major procedural complications occurred in three cases: brachial artery dissection in one and cardiac arrest in two. Postprocedure major vascular complications numbered three: claudicant pain on handgrip in one, ischemic index finger (with subsequent terminal phalanx amputation due to osteomyelitis) in one, and ischemic hand for 4 hr in one. Patients with contraindications to the femoral approach form a high-risk group. In these patients, transradial cardiac catheterization can be performed successfully and with a low risk of major complications. Minor adverse features remain frequent, occurring in one in five cases, though difficulties are minimized both with increasing operator experience and smaller sheath diameter.

The effect of external pressure, catheter gauge, andstorage time on hemolysis in RBC transfusion

RBC transfusions are often administered using externally applied pneumatic pressure. The effect of this practice on RBC hemolysis was studied during simulated transfusion performed in the laboratory. RBC transfusions were performed sequentially via 16-, 18-, 20-, and 22-gauge cannulas with the application of a pneumatic pressure device at pressures of 150 and 300 mm Hg. Hb concentration, Hct, RBC count, free Hb, potassium, and LDH concentrations were measured in 5 mL of transfusate. Forty-seven RBC units, 20 fresh units (mean age, 10.8 days) and 27 old units (mean age, 28.9 days) were studied under all conditions. Multiple regression analysis revealed that the age of the unit and the external pressure applied were significant determinants of the degree of hemolysis. The application of an external pressure device results in minimal destruction of transfused RBCs, even under the most stringent conditions examined. Thus, external pressure application to expedite an RBC transfusion is likely to be a safe procedure for the majority of patients. Unusual clinical situations, such as massive transfusion in pediatric patients, should be specifically examined to confirm the safety of this procedure.

Risk factors for pneumothorax during percutaneous Hickman line insertion in patients with solid and haematological tumours.

The purpose of this study was to identify risk factors for pneumothorax during percutaneous subclavian Hickman line insertion in patients with haematological (HT) or solid tumours (ST). One hundred and twelve patients (55 HT, 57 ST) had 132 subclavian Hickman lines inserted under fluoroscopic control. Lines were inserted on the left on 116 occasions and the right in 16. Thirty-five single, 29 double and 68 triple lumen catheters were inserted. Variables included in the analysis were age, sex, side of insertion, catheter gauge and nutritional status as indicated by the body mass index (BMI kg/m2). Both univariate and logistic regression analyses were performed. There were ten pneumothoraces, all occurring in patients with STs. Univariate analysis revealed that patients with STs were older (median age 59 versus 36 years; P = 0.0001) and more cachectic (median BMI 21.9 versus 24.2 kg/m2; P = 0.03) than those with HTs, and the patients experiencing pneumothorax were older (median age 57 versus 44 years; P < 0.01) and more cachectic (median BMI 19.6 versus 24.0 kg/m2; P = 0.004) than those undergoing uncomplicated procedures. For patients with a BMI < 19 kg/m2 versus those with a BMI > 19 kg/m2, the pneumothorax rate was 5/8 versus 5/124 (P < 0.00001). Logistic regression analysis confirmed the significantly older age of the patients with STs (P < 0.001) and of those experiencing pneumothorax (P = 0.02). This analysis also confirmed the lower BMI of patients experiencing pneumothorax (P = 0.002). The patients' sex, the side of line insertion and the catheter gauge were not associated with pneumothorax on either the univariate or logistic regression analyses. From these data we conclude that pneumothorax complicating a subclavian Hickman line is significantly more likely in elderly patients with a low BMI. Such patients are more likely to have STs than HTs. In patients with a BMI < 19 kg/m2, the subclavian route should be used with caution.

An audit of hickman catheter use in patients with solid tumours

The purpose of this study was to analyse the use and relative complication rates of Hickman lines inserted by angiographic and surgical routes in patients with solid tumours. Sixty-one patients (median age 55 years; range 21–81) with solid tumours had 71 Hickman catheters inserted. Fifty-three patients had 58 catheters inserted angiographically and eight patients had 13 catheters inserted surgically. Indications were as follows: for administration of infusional chemotherapy (48 patients), poor venous access (nine patients), needle phobia (four patients). The catheters remained in situ for 7981 days (median 105; range 10–750). Immediate complications occurred only in angiographically placed catheters (ten pneumothoraces, one tachydysrhyth-mia). Pneumothorax was associated with poor nutritional status but not with age, side of insertion or catheter gauge. The median body mass indices (BMIs) were 19.65 kg/m 2 and 22.8 kg/m 2 in those with and without pneumothorax respectively ( P = 0.0045). Five of six patients with BMI <19 kg/m 2 developed a pneumothorax, compared with five of 52 with BMI >19 kg/m 2 ( P = 0.0003). The overall sepsis rate was 2.38 per 1000 catheter days. Systemic sepsis was significantly increased for surgically inserted lines (3.94 versus 0.60 per 1000 catheter days; P = 0.001), although there was no significant difference in superficial sepsis (2.36 versus 1.04 per 1000 catheter days; P = 0.22). We conclude that Hickman catheters provide safe, long-term venous access in patients with solid tumours. Angiographic insertion carries a greater risk of acute complications in patients of poor nutritional status but a significantly lower risk of late systemic infective complications. Angiographic insertion is our method of choice, but the subclavian route should be avoided in cachexic patients because of the risk of pneumothorax.

Effects of alkalinization of lidocaine on the pain of skin infiltration and intravenous catheterization

Study Objective: To test the hypothesis that alkalinization of lidocaine decreases the pain of skin infiltration in surgical patients. Design: Double-blind, randomized, prospective study. Setting: Preoperative holding units, Brigham and Women's Hospital. Patients: 184 adult surgical patients. Interventions: We compared the efficacy of 1% lidocaine with and without 0.1 mEq/ml of sodium bicarbonate (NaHC0 3) for relief of pain of (1) skin infiltration and (2) intravenous (IV) catheterization prior to surgery. Measurements and Main Results: Patients evaluated the intensity of pain using a 100 mm visual analog scale (VAS). There were no differences between study groups (lidocaine with NaHCO 3, n = 89; lidocaine alone, n = 95) with respect to site of catheterization or catheter gauge used. Lidocaine plus NaHC0 3 caused significantly less pain on skin infiltration (median VAS = 4; range = 0 to 51) than did lidocaine alone (VAS = 8; range = 0 to 48; p < 0.008). Pain of IV catheterization also did not differ between groups. There was a weak correlation between catheter gauge and pain of IV catheterization (r = −0.19; p = 0.01). Conclusions: Pain resulting from skin infiltration of lidocaine solutions can be diminished by adding NaHC0 3 However, catheter size is more important than the presence or absence of NaHC0 3 in determining the pain of IV catheterization.

Fetal renal biopsy: technique development.

Fetal/neonate kidneys obtained at the time of autopsy were utilized to determine a suitable needle biopsy gauge to obtain renal parenchyma for histologic evaluation. Twenty-one fresh kidney specimens from 11 fetuses/neonates between 16-40 weeks gestation were used to obtain needle biopsies using 20-, 18-, 16-, and 14-gauge biopsy catheters. The specimens were graded according to the presence of normal histologic features of renal parenchyma. Seventy-five renal biopsies were obtained. The biopsy histology was interpreted using a grading system based on the presence of normal features of the renal parenchyma. Sixty-three (84%) of the samples were graded histologically as adequate (cortex or medulla present). Samples with both cortex and medullary structures present (completely adequate) were obtained in 39/63 (62%) of these adequate biopsies. The 14- and 16-gauge biopsy catheters gave the best results, respectively yielding 79 and 69% completely adequate biopsies. This is in contrast to the 20- and 18-gauge catheters that respectively yielded 35 and 25% completely adequate biopsies. Our initial results indicate that adequate kidney biopsies can be obtained. However, the current technique is associated with core sample disruption when the smaller gauge catheters are used. This could account for the low rate of completely adequate samples with the smaller gauge catheters. A different sampling technique is needed to overcome sample disruption, to determine the smallest catheter gauge that will yield a suitable tissue sample for histologic evaluation.

In vitro and in vivo rates of fluid flow through catheters in peripheral veins of dogs

Summary In vitro and in vivo fluid flow rates of 14-, 16-, 18-, and 20-gauge catheters at fluid heights of 0.91 and 1.75 m above the catheters were determined. Flow rates were significantly faster in vitro than in vivo, at a greater height, and with larger catheter radius. In vivo flow rates averaged 7% less than in vitro flow rates. Fluid flow increased approximately 50% for each gauge catheter when the height was raised from 0.91 to 1.75 m. Flow rates increased linearly with increasing catheter radius. The flow rate of each gauge of catheter was significantly different from flow rates of all other gauges that were used. In vivo flow rates for 14-, 16-, 18-, and 20-gauge catheters at fluid heights of 0.91 and 1.75 m were 137, 88, 75, and 45 ml/min and 206, 152, 114, and 75 ml/min, respectively. Knowledge of flow rates allows selection of a catheter gauge that will provide adequate volume loading for the size of patient being treated in the time needed.

Differential Flow from Multihole Epidural Catheters

The pressures used in vivo to administer epidural doses of local anaesthetic were recorded for 16- and 18-gauge multihole catheters. Observations were made on 10 patients in labour for each catheter gauge. The pressure range for the 16-gauge catheters was 39.9-266 kPa, with a mean of 167.2 kPa, and for 18-gauge, a range of 53.2-266 kPa, mean, 159 kPa. Similar pressures were then applied in vitro to 10 catheters of each gauge, and the flow of fluid observed from the three holes. For each size of catheter, with increasing pressure, flow appeared at the proximal, then the middle, and finally the distal hole. This emphasises that the effect of epidural doses can vary depending on the pressure of injection, especially if the catheter had been passed partially through the dura.

Differential flow from multihole epidural catheters.

The pressures used in vivo to administer epidural doses of local anaesthetic were recorded for 16- and 18-gauge multihole catheters. Observations were made on 10 patients in labour for each catheter gauge. The pressure range for the 16-gauge catheters was 39.9-266 kPa, with a mean of 167.2 kPa, and for 18-gauge, a range of 53.2-266 kPa, mean, 159 kPa. Similar pressures were then applied in vitro to 10 catheters of each gauge, and the flow of fluid observed from the three holes. For each size of catheter, with increasing pressure, flow appeared at the proximal, then the middle, and finally the distal hole. This emphasises that the effect of epidural doses can vary depending on the pressure of injection, especially if the catheter had been passed partially through the dura.

An intra-arterial induction gauge.

A flexible collapsible catheter gauge that can be introduced into an artery through a French 7 catheter is described. It expands when entering a wide blood vessel or tubular organ and the degree of expansion is measured by electromagnetic induction. The sensor consists of two collapsible congruent wire loops, one of which acts as the primary and the other one as the secondary of a transformer. The output of the secondary varies as the logarithm of the artery diameter over a wide range. Variations as small as 0.01 mm in a 10-mm-diameter lumen can be recorded. The paper describes construction of the probe and presents examples of nonradiographic measurement of arterial diameters as well as of recording of pulsatile changes in artery diameter in dogs.

Isolated pulmonary artery coarctation and pulmonary hypertension.

Radiologic studies on children with pulmonary hypertension disclosed 4 instances in which the only associated abnormality was a coarctation of one branch of the pulmonary artery. In the past this has been considered a rare congenital anomaly. In seeking to establish a causal relationship, similar unilateral constrictions were produced in dogs. The first branch of the pulmonary artery was constricted in 5 young puppies. After several months, pulmonary arterial pressure was measured by catheter and strain gauge manometer. Pulmonary angiographic studies were then performed and these clearly demonstrated the constrictions which had been induced. Correlative histologic studies are being done on the dogs which succumbed. The results of these preliminary studies have been very encouraging. Pulmonary arterial pressure and/or right ventricular pressures were elevated in four of the five young dogs studied. (Fig. 1, a typical pressure curve from the right ventricle, shows an elevation from the normal 30 mm. Hg syst...

The Catheter Gauge for Measuring the Pupil

The Catheter Gauge for Measuring the Pupil