Key result
Heparin-bonded pulmonary artery catheters show early balloon thrombosis and late structural cracking during prolonged use.
Why the study?
This study investigated thrombus formation and platelet aggregation on the balloon and shaft of heparin-bonded pulmonary artery catheters in critically ill patients using scanning electron microscopy.
Does the duration of indwelling heparin-bonded pulmonary artery catheters affect ultrastructural thrombus formation and platelet aggregation on the balloon and shaft in critically ill patients?
Observational (n=10)
No
Does the duration of indwelling heparin-bonded pulmonary artery catheters affect ultrastructural thrombus formation and platelet aggregation on the balloon and shaft in critically ill patients?
Answers are grounded in this paper and cite their sources.
Heparin-bonded pulmonary artery catheters still develop significant balloon thrombus formation and structural cracks within 72 hours of insertion in critically ill patients, coinciding with a significant drop in heparin release after 24 hours.
Objective To investigate heparin-bonded pulmonary artery catheters with respect to thrombus formation and platelet aggregation at the balloon and the shaft using a scanning electron microscope in critically ill patients. Design Prospective study. Settings Critical care unit and research laboratories. Patients Pulmonary artery catheters were inserted in critically ill patients (n = 10). Interventions Pulmonary artery catheters were removed after 24, 48, 72, or 120 hrs, and the ultrastructure was investigated in specialized research laboratories. Measurements and main results Balloon and shaft were investigated using a scanning electron microscopic technique. Area of thrombus formation was quantified using image analysis. Heparin release of the catheters was measured. The frequency of balloon inflations was investigated in in vitro experiments by inflating catheters different times (0, 10, 20, and 30 times). Twenty-four hours after catheter insertion, scanning electron microscopic images showed thrombus formation and platelet aggregation at the site of the balloon. Seventy-two hours after catheter insertion, a thrombus started to detach. The areas of thrombus formation did not differ, but thrombus organization changed dramatically 72 and 120 hrs after catheter insertion. The shaft was colonized by single cells only. Cracks of the balloon could be observed after 72 hrs, whereas no cracks could be found in in vitro controls. In vitro, heparin release of the pulmonary artery catheters decreased significantly after 24 hrs. Conclusions Scanning electron microscopic images of heparin-bonded pulmonary artery catheters demonstrate thrombus formation on the balloon 24 hrs after pulmonary artery catheter insertion, increasing dramatically at 72 and 120 hrs. The shaft was colonized by single cells only. The thrombus size is not significantly different during the observation time, but the grade and quality of thrombus formation differ.
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Hofbauer et al. (2000) conducted an observational in Critically ill patients requiring pulmonary artery catheterization (n=10). Heparin-bonded pulmonary artery catheter vs. In vitro control catheters and comparison across catheterization durations (24, 48, 72, or 120 hours) was evaluated on Thrombus formation, platelet aggregation, and ultrastructural changes at the balloon and shaft. Heparin-bonded pulmonary artery catheters showed balloon thrombus formation at 24 hrs and detachment with balloon cracks at 72 to 120 hrs in 10 patients.
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