Rapid large-volume fluid administration through a multi-lumen central venous catheter: a simple modification
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CORRESPONDENCE
Rapid large-volume fluid administration through a multi-lumen central venous catheter: a simple modification Hilary P. Grocott, MD, FRCPC, FASE . Ravi Raj, MD . Hessam H. Kashani, MD, MSc
Received: 3 October 2019 / Revised: 8 October 2019 / Accepted: 9 October 2019 Ó Canadian Anesthesiologists’ Society 2019
To the Editor, The need for large volume and rapid fluid/blood administration is a common occurrence in the perioperative setting. Nevertheless, large-bore intravenous access for vigorous fluid administration is often not available. Indeed, even with central venous access, standard multi-lumen central venous catheters often have limited flow characteristics because of their relatively small-diameter lumens and longer lengths. Herein, we propose a method to modify a multi-lumen central catheter to allow for rapid large-volume fluid administration using materials commonly available in the operating room.1 One Hi-FloTM4-Way Stopcock (Smiths Medical ASD Inc., Dublin, OH, USA) was connected to each of the Luer lock connections on a 16 cm 7 Fr. Two-Lumen Blue FlexTipÒ ARROWg?ard BlueÒ Catheter (Arrow International, Inc.; Reading, PA, USA) (Figure). The high-flow stopcocks were then connected to each other using a Double Male Luer Lock (Smiths Medical ASD, Inc.; Dublin, OH, USA) connector. The stopcocks were then connected at their proximal end to a single large-bore intravenous tubing attached to a large volume rapid
transfusion system (FMS 2000 Fluid Management System, Belmont Instrument Corporation, Billerica, MA, USA). The stopcocks could be sequentially toggled to allow for flow through either lumen, or for simultaneous flow through both lumens of the catheter. We tested this modified multi-lumen central venous catheter in simulated attempts to rapidly administer fluid with flow through either lumen, or for simultaneous flow through both lumens (n = 5, each configuration). After priming the FMS 2000 device with 500 mL of Ringer’s lactate, the distal end of the central venous catheter was inserted into the device’s hard-shell reservoir (to continuously recycle the priming fluid) and the automated 500 mLmin-1 setting was activated on the device’s control panel. After a steady state of fluid administration was established (approximately 15–20 sec), the pressure in the system (automatically displayed by the FMS 2000) was recorded as was the maximum flow rate attainable. With flow directed through both lumens of the two-lumen central venous catheter, rapid fluid administration was achieved (up to 320 mLmin-1; Figure). This is considerably greater than that obtained through each lumen alone.
H. P. Grocott, MD, FRCPC, FASE (&) R. Raj, MD H. H. Kashani, MD, MSc Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada e-mail: [email protected]
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A
C
B
Pressure (mmHg) Flow Rate (mL·min-1)
Distal Lumen
Proximal Lumen
Combined Lumens
288 (12)
293 (7)
291 (5)
77 (3)
247 (4)
320 (7)
Figure Transfusion device li
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