Chronic Indwelling Venous Catheters Research Articles

Obtaining Access in Patients with Indwelling Vascular Access Devices

Chronic indwelling catheters are used increasingly for outpatient and inpatient therapy. Because more patients care for indwelling devices at home, indwelling lines are available to emergency department staff to draw blood and administer medications, blood products, and intravenous fluids. This article discusses the indications, complications, and methods of accessing chronic indwelling venous catheters.

Hemorrhage from the inferior vena cava versus the ear artery: a comparison of cardiovascular and hormonal responses in conscious rabbits

There are inherent complications associated with chronic indwelling venous catheters for use as bleed catheters in long term hemorrhage experiments in conscious animals. As an alternative we have developed a protocol for bleeding conscious rabbits using a disposable catheter in the central ear artery. Previously we had bled rabbits through a catheter chronically implanted in the inferior vena cava (IVC); thus, we were interested in any potential differences in the hormonal (vasopressin and renin) and cardiovascular profile during hemorrhage between the IVC and ear artery bleeds. Rabbits underwent two bleeds, 1 week apart, one using the indwelling IVC catheter and the other with an ear artery (EA) catheter. We compared the mean arterial pressure (MAP), heart rate (HR), plasma vasopressin (AVP), and plasma renin activity (PRA) before and during hemorrhage. Baseline cardiovascular and hormonal values were the same, regardless of choice of bleed site. In addition there were no differences between bleed sites in the rate of fall of MAP (slope: IVC, 0.24 +/- 0.05; EA, 0.26 +/- 0.04) and the rate of rise of HR (slope: IVC, -1.37 +/- 0.22; EA, -1.20 +/- 0.19). Finally the AVP and PRA values associated with a MAP of 50 mmHg (1 mmHg = 133.3 Pa) (close to peak levels achieved during the hemorrhage) were also not different between IVC and EA bleeds. Given that the profiles of the bleeds were not different and that surgical implantation, possible infection, and daily flushing were avoided by the use of the EA catheter, we concluded that use of the EA as a site for bleeding conscious rabbits was justified.

Dopaminergic stimulation of oxytocin concentrations in the plasma of male and female monkeys by apomorphine and a D2 receptor agonist.

Administration of the dopamine receptor agonist apomorphine causes a dose-dependent increase in plasma oxytocin concentrations and dose-specific behavioral changes in rodents. To investigate whether dopamine receptor agonists will elicit similar neuroendocrine and behavioral effects in primates, we administered graded doses of apomorphine and the respective dopamine D1 and D2 receptor agonists, CY 208-243 and LY 163502, to monkeys and monitored plasma concentrations of oxytocin and behavior. Five female rhesus, two male rhesus, and two male cynomolgus monkeys had chronic indwelling venous catheters implanted and were maintained on standard jacket/tether/swivel systems to allow remote blood sample collection. During experiments, blood samples were collected 10 and 5 min before drug injection and at 2- to 120-min intervals after each injection. Apomorphine (50-400 micrograms/kg) and LY 163502 (10-100 micrograms/kg) elicited dose-dependent stimulations of oxytocin secretion. CY 208-243 (100-400 micrograms/kg) did not significantly affect oxytocin secretion. Low doses of apomorphine (50-100 micrograms/kg) and LY 163502 (10-25 micrograms/kg) elicited yawning, and high doses of apomorphine (200-400 micrograms/kg) and LY 163502 (50-100 micrograms/kg) elicited stereotypic behaviors. No behavioral effects of CY 208-243 (100-400 micrograms/kg) were observed. The magnitude of the oxytocin secretory responses varied among animals, but was similar in male and female monkeys. In summary, apomorphine and LY 163502 both elicited dose-related stimulation of oxytocin secretion coupled with dose-specific behavioral changes in male and female monkeys, while no effects of CY 208-243 on these parameters were observed. We conclude that dopamine receptor agonists, and in particular D2 agonists, may be useful tools for studies exploring the physiological and behavioral actions of oxytocin in primates.

Treatment of Superior Vena Cava Thrombosis with Recombinant Tissue Type Plasminogen Activator

Thrombotic occlusion of the superior vena cava is an uncommon but serious complication of chronic indwelling venous catheters. Several reports have shown thrombolytic therapy with intravenous streptokinase or urokinase to be effective in the treatment of this condition. We report a case of superior vena cava thrombosis in a 53-year-old woman receiving chemotherapy for breast carcinoma through a subcutaneously implanted venous access catheter who was successfully treated with peripheral infusion of recombinant tissue type plasminogen activator (rtPA).

Suppression of Pulsatile Luteinizing Hormone and Testosterone Secretion during Short Term Food Restriction in the Adult Male Rhesus Monkey (Macaca mulatta)*

To determine whether signals occurring during the early stages of undernutrition can have a suppressive effect on the central drive to the reproductive axis, the effects of 1 day of fasting on pulsatile LH and testosterone secretion were examined in adult male rhesus monkeys. Monkeys were maintained with chronic indwelling venous catheters on tether/swivel systems. One day of fasting caused a small weight loss of 0.1-0.2 kg, which represented a loss of 1-3% of the initial body weight. On a day of normal feeding monkeys showed a mean of 4.57 +/- 0.53 LH pulses/12 h (measured from 1900-0700 h). On a subsequent day of fasting LH pulse frequency was significantly reduced to 1.86 +/- 0.46 pulses/12 h (P less than or equal to 0.05). Likewise, there was a similar decrease in testosterone pulse frequency on a day of fasting. The substantial decrease in LH/testosterone pulse frequency was not caused by the intensive blood-sampling regimen, in that collection of blood samples for 12 h on 2 consecutive days of normal feeding did not result in a decrease in either LH or testosterone pulse frequency. Administration of exogenous GnRH in doses of 0.05-0.3 microgram/kg caused LH pulses of similar magnitudes on a day of normal feeding and a day of fasting, suggesting that the decrease in LH pulse frequency during the day of fasting reflects a decrease in GnRH stimulation of the pituitary rather than a loss of pituitary sensitivity to GnRH. Measurement of pulsatile LH across 3 consecutive days (e.g. a day of normal feeding, a day of fasting, and a day of refeeding) indicated that LH pulse frequency is slow before the time that the meal is missed on the second day and remains low throughout the day of fasting (normal feeding, 7 +/- 1.16 pulses/24 h; fasting, 3.33 +/- 0.33 pulses/24 h). Refeeding a normal meal at 1100 h on the third day resulted in an immediate and sustained increase in pulsatile LH secretion above normal frequency (11.07 +/- 0.33 pulses/24 h). These results indicate that very brief periods of undernutrition can significantly suppress the central drive to the reproductive axis in male rhesus monkeys, and this suppression can be rapidly reversed by refeeding. These findings argue against the hypothesis that undernutrition only suppresses central drive to the reproductive axis once a substantial amount of body weight has been lost.

Effect of chronic administration of different Bence Jones proteins on rat kidney

The role of Bence Jones proteins (BJPs) in the genesis of the renal dysfunction that develops in patients with multiple myeloma is not clearly defined. We previously evaluated renal function and morphology in a unique strain of rats (LOU/m) bearing tumors which synthesized BJPs with isoelectric points of 5.2, 4.3 and 6.7. Myeloma cast nephropathy developed in one tumor bearing group (pI 5.2), tubular necrosis was observed in another (pI 4.3), and renal function and histology remained normal in a third group (pI 6.7). To see if these renal outcomes were a function of the BJP being excreted or other factors which could be present in the tumor bearing animals, we have examined the effect of chronic intravenous administration of these three BJPs on renal function and histology in non-tumor-bearing LOU/m rats. Urine containing the BJP was collected from tumor bearing rats, sterilized by passage through a 0.2 mu millipore filter, concentrated to 50 mg/ml, and dialyzed extensively so as to remove material with a molecular weight less than 3500. Chronic indwelling-venous catheters were placed in non-tumor-bearing LOU/m rats and these rats were given 100 mg/day for five days of one of the three BJPs. Polyfructosan clearance (Cin) was measured prior to and following the five days of BJP administration. Renal histology was examined at the completion of the second Cin. In the pI 5.2 group (N = 6), a severe distal nephron cast nephropathy occurred and Cin fell from 2.88 +/- 0.24 to 0.90 +/- 0.17 ml/min (P less than 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)

Stimulation of ovine placental lactogen secretion by arginine infusion.

Arginine has been demonstrated to be a potent stimulus to GH and PRL secretion. To determine the effect of arginine on plasma ovine placental lactogen (oPL) concentrations, arginine (50 g in 350 ml distilled water, pH 7.4) or hypertonic saline of identical volume, osmolality, and pH was infused iv over a 30-min period into nine pregnant ewes, and blood samples from chronic indwelling venous catheters were obtained at frequent intervals before and for 8 h after the infusions. After the infusion of hypertonic saline, plasma oPL concentrations (measured by homologous RIA) decreased 20--50% over 1--2 h and then returned to baseline concentrations. After the infusion of arginine, plasma oPL concentrations also decreased by 20--50% for 1--2 h. However, 2--3 h after the infusion, plasma oPL concentrations in creased 79--115% (delta = 204--700 ng/ml) over preinfusion concentrations in seven ewes and 454% (2930 ng/ml) and 1142% (2042 ng/ml) in two ewes and remained elevated for the remainder of the 8-h interval. When the amount of arginine infused was reduced from 50 to 25 g, an increase in plasma oPL concentrations occurred in only one of five ewes. Plasma oPL concentrations increased by 8--58% after infusions of 50 g alanine or glycine but did not increase after 50 g glutamic acid. The delayed oPL response to arginine suggests that the increase in plasma oPL concentrations is not caused directly by arginine but rather by changes in the synthesis, secretion, and/or degradation of oPL induced indirectly by arginine.

EFFECT OF CORTICOTROPHIN ON CORTISOL SECRETION IN CASTRATED RHESUS MONKEYS

Wisconsin Regional Primate Research Center, University of Wisconsin, Madison, Wisconsin 53706, U.S.A. (Received 22 May 1978) In a wide variety of species corticotrophin (ACTH) is known to stimulate the synthesis and secretion of adrenocortical steroids. Studies with rhesus monkeys have shown that these responses can be affected by a number of factors including the method of handling and the type of physical restraint (Mason, 1959). In addition, androgens may depress plasma levels of glucocorticoids in primates (Brown & Migeon, 1956; Huis in't Veld, Louwerens & van den Spek, 1960). It was therefore decided to study the response of plasma cortisol to ACTH without these neural or hormonal influences. This report describes the effects of ACTH on castrated rhesus monkeys adapted to chronic restraint. Four chair-restrained, orchidectomized rhesus monkeys (Macaca mulatta) bearing chronic indwelling venous catheters were used as experimental subjects and were housed, maintained and subjected to blood sampling as

Effect of luteinizing hormone-releasing hormone on the secretion of luteinizing hormone, follicle-stimulating hormone, and testosterone in adult male rhesus monkeys.

Plasma levels of radioimmunoreactive LH, FSH, and testosterone (T) were assayed before and after administration of synthetic gonadotropin-releasing hormone (GnRH) to five chair-restrained rhesus monkeys with chronic indwelling venous catheters. Intravenous injection of 1, 5, and 25 microgram or infusion of 1 microgram/min for 25 min of GnRH resulted in a significant increase in plasma levels of LH. However, no significant increases in plasma FSH levels were detected. Plasma levels of T were also elevated after administration of 25 microgram GnRH, but peak concentration of T lagged behind peak levels of LH by approximately 30 min. These studies indicate that the male rhesus responds to GnRH administration by increased secretion of LH, followed by an increase in T levels. A concomitant increase in plasma FSH was not observed after treatment with GnRH in the doses used.

Plasma growth hormone response to capture and venipuncture in caged monkeys.

SummaryA large percentage of very high plasma immunoreactive growth hormone values was observed in cage-housed rhesus monkeys after net capture and manual restraint for saphenous venipuncture during about a 5-min period. Following chair restraint, mean values were significantly lower, but individual values were still somewhat variable apparently in relation to saphenous venipuncture alone, as judged by lower and less variable values obtained by means of remote blood sampling through chronic indwelling venous catheters. The present findings suggesting marked plasma growth hormone responses in the monkey to net capture, handling, and venipuncture, occurring within about a 5-min period, add emphasis to the need to consider not only the sensitivity of this endocrine system to psychological influences, but also the rapidity with which psychoendocrine responses may be reflected in growth hormone levels, even within the time of a single venipuncture.