Mechanism of Thrombogenesis during Total Parenteral Nutrition: Role of Catheter Composition

Abstract

Catheter material is considered as one of the main factors of deep venous thrombosis during parenteral nutrition. The effects of five types of catheters (polyethylene, polyurethane, silicone, TFE Teflon, and FEP Teflon) on the vein wall and on the blood flow were compared. Experiments were performed on rabbits in which catheters were inserted into the vena cava. Five series of experiments were performed, each including five animals with the same type of catheter. After 10 days, venograms of the vena cava were performed, animals were then killed and the vena cava was removed with the catheter in situ. The vein and the catheter were macroscopically examined; in cases with thrombosis the clot was weighed. The vein wall and the catheter were examined by conventional microscopy and by electron microscopy, respectively. Obstruction of the venous lumen were significantly more frequent with the rigid catheters than with the soft catheters (p < 0.001). The most extensive thromboses occurred with the Teflon catheters. The incidence of fibrin sleeves was significantly higher with the soft catheters than with the rigid ones (p < 0.01). The venographic and macroscopic findings were in agreement in 60-100% of the cases according to the degree of venous obstruction. Catheter surfaces remained unchanged in all cases. The polyethylene catheters induced the most severe intimal inflammatory reactions. Thrombus formation was caused by two mechanisms depending on catheter composition: (1) turbulence caused by the catheter in the blood stream, and (2) platelet aggregation and subsequently, fibrin deposition on the surface of the catheter. (Journal of Parenteral and Enteral Nutrition 12:190-194, 1988)

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References

Bozzetti F. , Scarpa D. , Terno G. , et al: Subclavian venous thrombosis due to indwelling catheters. A prospective study on 52 patients. JPEN 7:560-562, 1982

Di Costanzo J. , Sastre B. , Choux R. , et al: Experimental approach to prevention of catheter-related central venous thrombosis. JPEN 8:293-297, 1984

Linder LE , Curelarn I. , Gustavsson B. , et al: Material thrombogenicity in central venous catheterization: A comparison between soft antebrachial catheters of silicone elastomer and polyurethane. JPEN 8:399-406, 1982

Valerio D. , Hussey JK , Smith FW : Central vein thrombosis associated with intravenous feeding. A prospective study. JPEN 5:240-242, 1981

Warden GD , Wilmore D. , Pruitt BA : A hazard of medical progress. J Trauma 13:620-626, 1973

Welch GW , Mac Keel DW , Silverstein P. , Walker HL : The role of catheter composition in the development of thrombophlebitis . Surg Gynecol Obstet 138:421-424, 1974

Di Costanzo J. , Cano N. , Martin J. , Vadon D. : Venous thrombosis during total parenteral nutrition with central venous catheters. Role of nutritive solutions. Clin Nutr 1:201-205, 1982

Fonkalsrud EW , Pederson BM , Murphy J. , Beckerman JH : Reduction of infusion thrombophlebitis with buffered glucose solutions. Surgery 63:280-284, 1968

MacDonough JJ , Altmeier WA : Subclavian venous thrombosis secondary to indwelling catheters. Surg Gynecol Obstet 133:397-400, 1971

10.

Fabri PJ , Mirtallo JM , Ruberg RL , et al: Incidence and prevention of thrombosis of the subclavian vein during total parenteral nutrition. Surg Gynecol Obstet 155:238-240, 1982

11.

Ryan JA , Abel RM , Abbott WM , et al: Catheter complications in total parenteral nutrition. A prospective study of 200 consecutive patients. N Engl J Med 290:757-761, 1974

12.

Hoshal VL , Anse RG , Hoskins PA , Mich AA : Fibrin sleeve formation on indwelling subclavian central venous catheters . Arch Surg 102:353-358, 1971

13.

Peters WR , Bush WH , MacIntyre RD , Hill LD : The development of fibrin sheath on indwelling venous catheters. Surg Gynecol Obstet 137:43-47, 1973

14.

Ruggiero RP , Aisenstein T. : Central catheter fibrin sleeve. Heparin effect . JPEN 7:270-273, 1983