Swan-Ganz Pulmonary Artery Catheter Research Articles

Pulmonary artery catheter knot in a liver transplantation, a rare complication

The pulmonary artery catheter (PAC) measures hemodynamic parameters in real time, providing valuable data for the management of the critical patient. Nevertheless, its use is associated with several complications. Knot formation is a rare complication related to PAC insertion. A 51-year-old patient with complicated ethanolic liver cirrhosis underwent orthotopic liver transplantation. Invasive hemodynamic monitoring was performed using a Swan-Ganz pulmonary artery catheter (PAC) inserted through the right internal jugular vein. Chest X-ray in the immediate postoperative period showed the presence of a possible knot adjacent to the tip of the sheath in the internal jugular vein. The patient was then referred to the hemodynamics room, where, through fluoroscopy, a true knot was successfully removed after femoral vein dissection. The medical team should weigh the risk and benefit of using the PAC, taking into account the patient's clinical conditions, the benefits, and possible complications of the procedure.

Intraosseous fluid resuscitation causes systemic fat emboli in a porcine hemorrhagic shock model

BackgroundIntraosseous cannulation can be life-saving when intravenous access cannot be readily achieved. However, it has been shown that the procedure may cause fat emboli to the lungs and brain. Fat embolization may cause serious respiratory failure and fat embolism syndrome. We investigated whether intraosseous fluid resuscitation in pigs in hemorrhagic shock caused pulmonary or systemic embolization to the heart, brain, or kidneys and if this was enhanced by open chest conditions.MethodsWe induced hemorrhagic shock in anesthetized pigs followed by fluid-resuscitation through bilaterally placed tibial (hind leg) intraosseous cannulas. The fluid-resuscitation was limited to intraosseous or i.v. fluid therapy, and did not involve cardiopulmonary resuscitation or other interventions. A subgroup underwent median sternotomy with pericardiectomy and pleurotomy before hemorrhagic shock was induced. We used invasive hemodynamic and respiratory monitoring including Swan Ganz pulmonary artery catheter and transesophageal echocardiography and obtained biopsies from the lungs, heart, brain, and left kidney postmortem.ResultsAll pigs exposed to intraosseous infusion had pulmonary fat emboli in postmortem biopsies. Additionally, seven of twenty-one pigs had coronary fat emboli. None of the pigs with open chest had fat emboli in postmortem lung, heart, or kidney biopsies. During intraosseous fluid-resuscitation, three pigs developed significant ST-elevations on ECG; all of these animals had coronary fat emboli on postmortem biopsies.ConclusionsSystemic fat embolism occurred in the form of coronary fat emboli in a third of the animals who underwent intraosseous fluid resuscitation. Open chest conditions did not increase the incidence of systemic fat embolization.

Invasive hemodynamic monitoring by Swan-Ganz pulmonary artery catheter: concepts and utility

Since its beginnings in the last century, pulmonary artery catheterization (PAC) has evolved into an invasive hemodynamic evaluation technique that can be performed at the patient's bedside through a Swan-Ganz catheter; this procedure has maintained an intermittent course in terms of its use; however, it has currently demonstrated relevance in specific scenarios. The PAC allows access to the central venous circulation, the right heart and the pulmonary artery; it performs the calculation of hemodynamic variables directly or indirectly by means of established formulas and methods. This makes possible to perform an adequate hemodynamic evaluation and classification, perform specific tests (e.g. vasoreactivity test), which help to define the diagnosis, therapeutic , monitor the response to treatment, evaluation prior to advanced therapies (e.g. cardiac transplantation or mechanical circulatory assistance devices), and prognosis in our patients. In this article we discuss the concepts and usefulness of pulmonary artery catheterization.

Pulmonary hypertension as a risk assessment factor for unfavorable outcome in patients with COVID-19

Aim. To determine the predictive role of estimated pulmonary artery systolic pressure (ePASP) in COVID-19 patients.Material and methods. A retrospective study of inpatients with documented COVID-19 infection was carried out. Maximal follow-up period was 63 days. The study included 108 patients (men, 62; women, 46; mean age, 62,9±15,5 years). At admission, mean NEWS score was 6,0, blood oxygen saturation — 92%. Echocardiography was performed according to standard protocol using Vivid E9 ultrasound system (GE Healthcare). Quantitative measurements were performed according to the current ASE and EACVI guidelines. Statistical analysis was performed using the IBM SPSS Statistics v.26 software (developed by IBM Corporation).Results.Using the CHAID technique, a classification tree was developed and the strongest predictor of an unfavorable outcome was determined (ePASP). Threshold ePASP values, associated with an increased mortality risk were established (42 mm Hg and 50 mm Hg). Three groups of patients were selected based on the main predictor (<41,0 mm Hg, 42-49 mm Hg and >50 mm Hg). The increased mortality risk was noted in groups 2 and 3 compared to group 1 of patients and amounted to 31,8% and 70% versus 3,9%, respectively. There was also a correlation between the severity of CT lung parenchymal lesions according to computed tomography and the study groups of patients (36% [30-49%] — group 1, 50% [36-76%] — group 2, and 84% [56-92%] — group 3, p=0,001). In groups 2 and 3, the following complications were significantly more frequent: acute respiratory distress syndrome, acute heart failure, multiple organ system failure, venous thrombosis, disseminated intravascular coagulation. In group 3, acute renal failure and systemic inflammatory response syndrome developed significantly more often than in group 1.Conclusion.A comprehensive echocardiography has proven its availability and safety in assessing the condition of COVID-19 patients, allowing to obtain relevant information on pulmonary hemodynamics. Transthoracic echocardiography reduced the risk of complications from invasive diagnostic methods and allowed to abandon the use of the Swan-Ganz pulmonary artery catheter in the studied group of patients. As a result, a relationship was noted between the increase of ePASP and the severity of clinical performance and lung tissue damage according to computed tomography, changes in laboratory blood tests, the severity of the comorbid profile, an increase in respiratory support need.

Comparison of cardiac output using invasive (Pulmonary Artery catheter Continuous cardiac Output), less invasive (FloTrac) and non invasive (Pulse Wave Transit Time) methods in patients undergoing off pump coronary artery bypass grafting

Aim and Objective: This study was undertaken in patients undergoing off-pump coronary artery bypass grafting (OPCABG) with aim of comparing cardiac output using invasive pulmonary artery catheter continuous cardiac output (PAC CCO), less invasive (FloTrac pulse contour based) and non invasive pulse wave transit time (PWTT) methods. Materials and Methods: Longitudinal observational study carried out in the department of Anesthesiology (CVTS OT) of super speciality hospital tertiary care hospital run by state Government with total 995 data sets taken from 25 subjects undergoing off pump coronary artery bypass grafting. Swan Ganz pulmonary artery catheter was inserted through the right internal jugular vein through introducer sheath and attached to the Edward vigilance II continuous cardiac output monitor for continuous monitoring of cardiac output invasively. Similarly cardiac output was measured with less invasive (FloTrac) monitor attached to a dedicated left femoral artery line. Non invasive (Estimated Continuous cardiac output (esCCO) based on pulse wave transit time) monitor attached to ECG and Spo2 probe sensor & calibration done with non –invasive blood pressure (NIBP) and the required demographic characteristics entered. Results: Mean cardiac output assessed by invasive, less invasive and non invasive method was 3.91+/-0.87, 5.71+/-0.87 and 6.03 +/- 0.99 L/min respectively. There was poor correlation between less invasive and the invasive with r=0.25 and also poor correlation between non-invasive and invasive with correlation coefficient of r=0.27. Both less invasive (FloTrac) and non invasive methods (PWTT) showed higher estimation when compared to the invasive (PAC CCO). The Bland Altman analysis showed poor agreement between less invasive (FloTtrac) and the invasive (PAC CCO) method, whereas the non invasive (PWTT based esCCO) showed good agreement. Percentage error were 68% and 126% for non-invasive (PWTT based es CCO) and less invasive (FloTrac) respe

Pulmonary alveolar hemorrhage from a pulmonary artery false aneurysm after Swan-Ganz catheterization in a thoracic aortic aneurysm patient: a case report.

Pulmonary artery (PA) rupture caused by a PA Swan-Ganz catheter is a rare complication but remains fatal in almost 50% of cases. False aneurysm of the PA is a rare presentation of PA rupture and should be considered as a possible diagnosis in a patient with a new lung mass after PA catheterization. We present a case of sudden-onset pulmonary alveolar hemorrhage during cardiovascular surgery due to a traumatic PA false aneurysm. The Swan-Ganz catheter might have been displaced by the thoracic aortic aneurysm with displacement of the catheter causing the false aneurysm and bleeding.

A misplaced and entrapped pulmonary artery catheter

A misplaced and entrapped pulmonary artery catheter

Cardiac index value measurement by invasive, semi-invasive and non invasive techniques: a prospective study in postoperative off pump coronary artery bypass surgery patients

The authors prospectively compared three techniques of continuous cardiac index measurements. They were, invasive Continuous Cardiac Index using thermodilution flow-directed Swan-Ganz pulmonary artery catheters, semi invasive Flotrac-arterial pressure derived cardiac index and the non invasive cardiac index measurement-body impedance plethsmography. The cardiac index measurements were made simultaneously in the postoperative period in 20 patients who underwent elective uncomplicated off pump coronary artery bypass graft. The values were collected once in 5 min over a period of 30-40 min. A set of 140 values were obtained from the cohorts in our study. Inter-changeability of the values of cardiac index was analysed using Bland-Altman and mountain plots. The cardiac index values ranged from 1.6 to 3.6 l/min/m(2). The values obtained were interchangeable. The bias and precision respectively were 0.02 and +/-0.06 for continuous cardiac index and Flotrac, 0.18 and +/-0.08 for Flotrac and body impedance plethysmography and 0.16 and +/-0.08 for continuous cardiac index and body impedance plethysmography. Flotrac appears to be more useful during off pump coronary artery bypass surgery.

Validation of esophageal Doppler for noninvasive hemodynamic monitoring under pneumoperitoneum

Commonly used perioperative measurements of hemodynamics, such as Swan-Ganz catheter assessment, are invasive and may not be reliable under pneumoperitoneum. The purpose of this study was to validate the use of esophageal Doppler for noninvasive hemodynamic monitoring under pneumoperitoneum in an experimental pig model. Eight female pigs were submitted to two 30-min study periods, one each for the baseline (no interventions) and pneumoperitoneum (12-mmHg carbon dioxide pneumoperitoneum) conditions. One pig was excluded because of tachycardia (>140 at baseline). A Swan-Ganz pulmonary artery catheter was used to measure cardiac output (CO-SG) and pulmonary capillary wedge pressure (PCWP). An esophageal Doppler probe was inserted to record cardiac output (CO-ED) and corrected flow time (FTc), an index of preload. Transthoracic echocardiography was used to measure left ventricular end-diastolic diameter (LVEDD) and cardiac output (CO-TTE). Pearson correlation was used to assess individual associations between the measured hemodynamic parameters. There was good correlation between CO-ED and CO-SG (r = 0.577; p < 0.001) and excellent correlation between CO-ED and CO-TTE (r = 0.815; p < 0.001). There was no correlation between FTc and LVEDD or PCWP. These relationships were consistent when analyzed separately at baseline and during pneumoperitoneum. Esophageal Doppler monitoring is a valid noninvasive method of estimating cardiac output at baseline and during pneumoperitoneum in a porcine model. Corrected flow time did not correlate with other estimates of preload at baseline or during pneumoperitoneum.

EMBOLIC PULMONARY HYPERTENSION SHEEP MODEL BY CONTINUOUS VENOUS AIR INFUSION

Purpose: To develop a sheep model of chronic pulmonary hypertension to provide platform for research research on the artificial lung and right heart assist. Methods: Four adult female sheep were cannulated with a Swan-Ganz pulmonary artery catheter through the jugular vein under general anesthesia. Filtered air was infused continuously into the Superior Vena Cava (then to pulmonary circulation) at a rate of 0.4–4.0 ml/hour to induce pulmonary hypertension. Hemodynamics including heart rate (HR), mean arterial pressure (MAP), mean pulmonary arterial pressure (MPAP) and cardiac output (CO) were monitored continuously and recorded along with respiratory rate (RR) and blood gas analysis before the introduction of air embolism (as baseline) and every 12 hours after that. Results: All animals met criteria for pulmonary hypertension within 6–16 hours after initiation of air infusion. MPAP remained greater than 20 mmHg throughout the experiment (9–12d) with a maximum of 49 mmHg. The average MPAP on day 12 was 37 +/- 18 mmHg, which is statistically greater than baseline (15 +/- 0.6 mmHg) by two times. HR, MAP, and CO remained unchanged and blood gases were maintained within normal range throughout the study. All sheep experienced mild dyspnea (with RR of two-fold greater than baseline) and required mild sedation with diazepam. Conclusion: Our air embolic pulmonary hypertension model in sheep induced by continuous air central venous infusion appears clinically relevant and reproducable.

Cardiac ischemic preconditioning improves lung preservation in valve replacement operations

Background. Previous work has shown that cardiac ischemic preconditioning reduces cardiac reperfusion injury. We investigated whether cardiac ischemic preconditioning can improve lung preservation in patients who undergo valve replacement. Methods. Forty patients with rheumatic heart disease requiring valve replacement were randomly divided into two groups. Twenty patients received two cycles of 3 minutes of aortic cross-clamping and 2 minutes of reperfusion before cardioplegic arrest (group IP), and 20 patients underwent 10 minutes of cardiopulmonary bypass (group C, control group). Blood samples from the pulmonary vein were collected to measure levels of polymorphonuclear leukocytes, superoxide dismutase, malonedialdehyde, and thromboxane B 2, and arterial oxygen tension. Blood samples from the coronary sinus were used to measure calcitonin gene–related peptide values. Hemodynamic data were recorded by a pulmonary artery Swan-Ganz catheter. Lung tissue was collected after 1 hour of reperfusion to evaluate morphology. Clinical outcome data were recorded. Results. In group C (cardiopulmonary bypass and cardioplegic arrest), the levels of polymorphonuclear leukocytes, thromboxane B 2, malonedialdehyde, and calcitonin gene–related peptide were increased after 1 hour of reperfusion, whereas the value for superoxide dismutase was decreased. In group IP, preconditioning attenuated the increase in polymorphonuclear leukocytes, thromboxane B 2, and malonedialdehyde ( p < 0.05) and increased superoxide dismutase and calcitonin gene–related peptide levels ( p < 0.05). Preconditioning also increased arterial oxygen tension and cardiac index compared with controls ( p < 0.05) and decreased mean pulmonary artery pressure and pulmonary vascular resistance index ( p < 0.05). Histologic findings showed less lung injury and a lower polymorphonuclear leukocyte count in group IP than in group C ( p < 0.05). Group IP had fewer postoperative pulmonary complications and a shorter intubation time. Conclusions. Cardiac ischemic preconditioning improves lung preservation in patients having valve replacement. The mechanism may be that cardiac ischemic preconditioning reduces the accumulation of polymorphonuclear leukocytes in lung tissue and decreases the formation of oxygen free radicals.Key Words: Ischemic preconditioning; lung injury; open heart surgery; calcitonin gene–related peptide.

Impact of using an indwelling introducer on diagnosis of Swan-Ganz pulmonary artery catheter colonization

A prospective study was conducted to determine how the use of an indwelling introducer influences the diagnosis of pulmonary artery catheter (PAC) colonization. Sixty-six consecutive PACs and introducers were aseptically removed over a 15-month period. Two segments of the catheter and the catheter tip (a proximal segment from the portion of the catheter beneath the introducer) and two segments of the introducer (a proximal intradermal segment and the introducer tip) were cultured using a semiquantitative technique. Nineteen of 66 (28.7%) PACs showed colonization, representing an incidence of 5.6 episodes per 100 catheterization-days. Catheter tip cultures identified only 68% of colonized PACs; this yield rose to 91% when introducer tip cultures were added. These results indicate a need to evaluate both introducer tip cultures and catheter tip cultures for an accurate diagnosis of PAC colonization when an indwelling introducer is used.

Effect of low dose beta blockers on atrial and ventricular (B type) natriuretic factor in heart failure: a double blind, randomised comparison of metoprolol and a third generation vasodilating beta blocker.

This study examines the acute effects of two differing beta adrenergic blocking agents (metoprolol and a third generation vasodilating beta blocker) on plasma concentrations of atrial natriuretic factor (ANF), brain (ventricular) natriuretic factor (BNF), and haemodynamic variables in patients with heart failure. University teaching hospital. 20 patients with impaired left ventricular systolic function [ejection fraction 32 (SEM 2.3)%] were randomised in a double blind manner to receive either oral metoprolol 6.25 mg twice daily or celiprolol 25 mg daily. Haemodynamic variables were evaluated by Swan-Ganz pulmonary artery catheter over 24 hours. ANF and BNF concentrations were measured at baseline, 5 h, and 24 h by radioimmunoassay. At baseline ANF and BNF concentrations were considerably raised compared to the normal range. Treatment with metoprolol caused ANF to rise further to 147% of the basal level at 5 h (P = 0.017) and 112% at 24 h (P = 0.029). This was associated with a small but non-significant rise in pulmonary capillary wedge pressure. Cardiac output and systemic vascular resistance were unchanged at 24 h. In contrast, after celiprolol ANF fell to 90% of basal levels at 5 h and to 74% of basal level at 24 h (P = 0.019), associated with a small but non-significant fall in pulmonary capillary wedge pressure [-3.3 (2.7) mm Hg] and systemic vascular resistance, and rise in cardiac output from 3.2 (0.2) to 4.0 (0.4) l/min (P = 0.04). BNF concentrations rose to 112% of baseline at 5 h (P = 0.09) after metoprolol but fell slightly, to 91% of baseline values, after celiprolol (NS). Metoprolol, even in very low doses (6.25 mg), produced a rise in ANF and BNF, although minimal haemodynamic changes were detected. In contrast, a vasodilating beta blocker was associated with a significant fall in ANF and BNF and a small rise in cardiac output. This study confirms both the advantages of vasodilating beta blockers over metoprolol for initial treatment of heart failure and the usefulness of ANF and BNF measurements for the assessment of drug effects in heart failure compared to traditional haemodynamic measurements.

Infectious complications of Swan-Ganz pulmonary artery catheters. Pathogenesis, epidemiology, prevention, and management.

Infectious complications of Swan-Ganz pulmonary artery catheters. Pathogenesis, epidemiology, prevention, and management.

Surface Antimicrobial Activity of Heparin-Bonded and Antiseptic-Impregnated Vascular Catheters

Most Swan-Ganz pulmonary artery catheters have heparin bonded to the surface with benzalkonium chloride, a cationic surfactant, to reduce thrombosis. Since benzalkonium is bactericidal, the antimicrobial activity of heparin-bonded pulmonary artery catheters was investigated in an in vitro assay. Each catheter exhibited activity against a wide variety of potential microbial pathogens, including Candida albicans. The magnitude of activity against individual organisms correlated strongly with their in vitro susceptibility to benzalkonium chloride (r = .94, P < .002). A chlorhexidine-silver sulfadiazine-impregnated catheter exhibited even greater activity than the heparin-bonded catheters (P = .01). When exposed to serum for 24 h, heparin-bonded catheters lost > or = 50% of their antimicrobial activity, whereas the activity of the chlorhexidine-silver sulfadiazine-impregnated catheter was minimally affected. The fortuitous surface antimicrobial activity of heparin-bonded catheters may account for the low incidence of catheter-related bacteremia (mean, 1.0%) compared with Swan-Ganz catheters of the same materials but not coated with benzalkonium-heparin (mean, 2.8%).

The pathogenesis and epidemiology of catheter-related infection with pulmonary artery Swan-Ganz catheters: A prospective study utilizing molecular subtyping

To delineate the pathogenesis and epidemiology of catheter-related infection with Swan-Ganz pulmonary artery (PA) catheters, a prospective clinical study of hospitalized adult medical and surgical patients was done. Role of catheter material was assessed by randomizing insertions to heparin-bonded PA catheters made of polyvinylchloride or polyurethane. Sources of infection and pathogenesis were studied by culturing skin, the introducer, the PA catheter tip, all hubs, infusate from each lumen, and the extravascular portion of the PA catheter beneath the external protective plastic sleeve. Concordance between isolates from sources and infected catheters was determined by speciation, antibiogram, and for coagulase-negative staphylococci, plasmid profile analysis. Risk factors for infection were determined by stepwise logistic regression. Overall, 65 (22%) of 297 Swan-Ganz catheters showed local infection of the introducer (58 catheters) or the intravascular portion of the PA catheter (20 catheters); only two catheters (0.7%) caused bacteremia. Eighty percent of infected Swan-Ganz catheters (the introducer or PA catheter) showed concordance with organisms cultured from skin of the insertion site, 17% with a contaminated hub and 18% with organisms contaminating the extravascular portion of the PA catheter beneath the sleeve. Isolates from infected PA catheters were most likely to show concordance with concomitantly infected introducers (71%). Cutaneous colonization of the insertion site with > 10 2 cfu/10 cm 2 (relative risk [RR] 5.5; p < 0.001), insertion into an internal jugular vein (RR 4.3; p < 0.01), catheterization >3 days (RR 3.1; p < 0.01), and insertion in the operating room using less stringent barrier precautions (RR 2.1; p = 0.03) were each associated with a significantly increased risk of catheter-related infection. The risk of bacteremic infection with Swan-Ganz catheters is now low, in the range of 1%, with reasonable care. Swan-Ganz catheters are vulnerable to contamination from multiple sources, but the patient's skin is the single most important source of organisms causing invasive infection, which in most cases involves the introducer rather than the PA catheter. Heavy colonization of the insertion site, percutaneous insertion in the internal jugular vein rather than subclavian vein, catheterization longer than 3 days, and insertion with less stringent barrier precautions significantly increase the risk of catheter-related infection. These findings hold promise for application to management of Swan-Ganz catheters and research in catheter design to reduce the risk of catheter-related infection.

Severe maternal morbidity and fetal mortality caused by a diagnostic Swan-Ganz procedure: a case report

An eclamptic primigravid patient is presented in whom central monitoring by a Swan-Ganz pulmonary artery catheter led to a series of complications, including the Mendelson's syndrome of necrotisizing pneumonia, resulting in severe maternal morbidity and in fetal mortality.

Pulmonary vascular reactivity of the newborn pony foal

Adult ponies develop pulmonary hypertension at altitude (Bisgard, Orr and Will 1975), but the neonatal response to acute hypoxaemia is unknown. Seven foals aged five days were instrumented with a systemic and a Swan-Ganz pulmonary artery catheter while anesthetised and intubated. Cardiac index, pulmonary (PAP) and systemic (SAP) vascular pressures were measured as the foals breathed gas mixtures with FI02 of 8 to 94 per cent. Because foramen ovale or ductus arteriosus shunts might have altered thermodilution cardiac index measurements in the stressed foals, the ratio, PAP/SAP was calculated to define relative circulatory reactivity. Three foals, two of which were full siblings, had very marked elevation of PAP/SAP from 0.6 to 1.41 at low inspired oxygen tensions. Four different foals attained maximal PAP/SAP of only 0.2 to 0.92 at similarly low oxygen tensions (P less than 0.0001). Thus, pulmonary vascular reactivity to ventilatory hypoxaemia varied greatly in pony foals of the same age. The exaggerated reactivity in related foals suggested that, as in cattle, a genetic predisposition to develop reactive pulmonary hypertension under hypoxaemic stress may exist.

Pulmonary artery false aneurysms secondary to Swan-Ganz pulmonary artery catheters.

Several complications from the use of balloon-tipped flow-directed (Swan-Ganz) pulmonary artery catheters are recognized. One infrequent but life-threatening complication is false aneurysm formation associated with rupture or dissection of the pulmonary artery. We report 10 cases of catheter-induced pulmonary artery false aneurysms identified during a 9-year period. Initial presentation was radiologic in six patients and clinical (hemoptysis) in four. Later chest radiographic findings consisted of a well-defined, persistent pulmonary nodule or mass (three patients) or focal, dense parenchymal consolidation (six patients) that either persisted (two patients) or evolved into a nodule or mass (four patients) adjacent to the catheter tip. Cavitation of a pulmonary mass developed in one case. Two of eight deaths were caused by pulmonary artery false aneurysm formation and rupture with subsequent fatal hemorrhage. In one patient who survived, the false aneurysm was shown by pulmonary angiography and embolized with coils and Gelfoam. We conclude that pulmonary artery false aneurysms are life-threatening complications of pulmonary artery catheters and have characteristic chest radiographic findings.

Pulmonary artery catheter infections. A prospective study.

Despite the widespread use of the Swan-Ganz pulmonary artery catheter, the incidence of catheter tip infection is not well-established. One-hundred and seventy catheter insertions in 113 patients were examined in this prospective study. Using a semiquantitative culture technique, the incidence of positive catheter tip cultures was 5.8%. No significant risk factors for catheter infection were identified, although there was a trend toward more frequent infection in patients not receiving antibiotics (p less than 0.06). Catheter tip infection appeared to result most frequently from a distant focus of infection. Although the overall incidence of positive blood cultures was significantly higher in the positive vs. negative catheter tip groups (37.9% vs. 10.6%, p less than 0.001), blood cultures were generally not a reliable guide to the presence of a catheter tip infection. We conclude that catheter infection can be contained at an acceptable level by following a reasonable protocol for catheter management.