Heart perforation by central venous catheters.

Since their introduction in the early 1950s, central venous catheters have become an indispensable tool in the operating room and in the intensive care unit. At least a dozen manufacturers currently sell these devices in North America, and more than 50,000 catheters are used in Canada each year. In a large metropolitan general hospital as many as I ,~00 catheters may be used in patients annually, with the anaesthetist being the major user. Perforation of the heart and the vena cava by central venous catheters inserted for central venous pressure (CVP) monitoring and for total parenteral nutritional (TPN) therapy have been reported, t-,~ In the past year, seven cases of perforation resulting in death were reported to the Health Protection Branch, Health and Welfare Canada~ ~'6 Six different brands of catheters were involved in these cases which occurred in six Canadian hospitals. The frequency of these reported incidents appears to agree with the reported frequency of occurrence of about two cases in a thousand applications. 7 Softer materials can reduce catheter stiffness s and therefore the potential for perforation. However, incidents involving catheters made of polyvinylchloride (PVC), polyethylene, polyurethane, and teflon have all been reported. 4'9 Silastic rubber is currently the softest material used for manufacturing catheters. Unfortunately, the added softness also makes the catheters unsatisfactory for monitoring of pressure-pulse profile, due to damping effects. For TPN and for monitoring of mean venous pressures, they may be safer to use, although tissue erosion, as a result of prolonged tissue contact and vessel wall exposure to hyperosmotic fluids may still result in