Catheter Explained

Catheter

In medicine, a catheter ([1]) is a thin tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgical procedure. Catheters are manufactured for specific applications, such as cardiovascular, urological, gastrointestinal, neurovascular and ophthalmic procedures. The process of inserting a catheter is called catheterization.

In most uses, a catheter is a thin, flexible tube (soft catheter) though catheters are available in varying levels of stiffness depending on the application. A catheter left inside the body, either temporarily or permanently, may be referred to as an "indwelling catheter" (for example, a peripherally inserted central catheter). A permanently inserted catheter may be referred to as a "permcath" (originally a trademark).

Catheters can be inserted into a body cavity, duct, or vessel, brain, skin or adipose tissue. Functionally, they allow drainage, administration of fluids or gases, access by surgical instruments, and also perform a wide variety of other tasks depending on the type of catheter.[2] Special types of catheters, also called probes, are used in preclinical or clinical research for sampling of lipophilic and hydrophilic compounds,[3] protein-bound and unbound drugs,[4] [5] neurotransmitters, peptides and proteins, antibodies,[6] [7] [8] nanoparticles and nanocarriers, enzymes and vesicles.

Etymology

"Catheter" (from Greek Greek, Ancient (to 1453);: καθετήρ kathetḗr) comes from the Greek verb Greek, Ancient (to 1453);: καθίεμαι kathíemai, meaning "to thrust into" or "to send down" because the catheter allowed fluid to be "sent down" from the body.[9]

Uses

Placement of a catheter into a particular part of the body may allow:

History

Ancient inventors

Ancient Chinese used onion stalks, the Romans, Hindus, and Greeks used tubes of wood or precious metals.[11]

The ancient Egyptians created catheters from reeds.

Modern

The earliest invention of the flexible catheter was during the 18th century.[12] Extending his inventiveness to his family's medical problems, Benjamin Franklin invented the flexible catheter in 1752 when his brother John suffered from bladder stones. Franklin's catheter was made of metal with segments hinged together with a wire enclosed to provide rigidity during insertion.[13] [14]

According to a footnote in his letter in Volume 4 of the Papers of Benjamin Franklin (1959), Franklin credits Francesco Roncelli-Pardino from 1720 as the inventor of a flexible catheter. In fact, Franklin claims the flexible catheter may have been designed even earlier.[15]

An early modern application of the catheter was employed by Claude Bernard for the purpose of cardiac catheterization in 1844. The procedure involved entering a horse's ventricles via the jugular vein and carotid artery.[16]

In 1929, Werner Forssman first performed central venous catheterization,[17] work which led to the development of cardiac catherization as a treatment, for which he, André F. Cournand and Dickinson W. Richards would win the Nobel Prize for Medicine in 1959.[18] Central venous catheterization allows for continuous administration of medications, fluids and blood products to a large vein, particularly in critically ill patients. Cardiac catheterization is the insertion of a catheter into one of the chambers of the heart, which is used for imaging, diagnosis, and the placement of devices such as stents.

David S. Sheridan invented the modern disposable catheter in the 1940s.[19] Prior to this, some reusable catheters consisted of braided cotton tubes, which were varnished, heat-treated and polished. As these were primarily produced in France, the advent of World War II threatened the supply chain.[20] Sheridan was dubbed the "Catheter King" by Forbes magazine in 1988. He also invented the modern "disposable" plastic endotracheal tube now used routinely in surgery.

Other reusable catheters consisted of red rubber tubes. Although sterilized prior to reuse, they still posed a high risk of infection and often led to the spread of disease.[21]

To prevent clotting, catheters that are not in use may be filled with catheter lock solution.[22]

Materials

Urinary catheters

A range of polymers are used for the construction of catheters, including silicone rubber, nylon, polyurethane, polyethylene terephthalate (PET), latex, and thermoplastic elastomers. Silicone is one of the most common implantable choice because it is inert and unreactive to body fluids and a range of medical fluids with which it might come into contact. On the other hand, the polymer is weak mechanically, and a number of serious fractures have occurred in catheters.[23] [24] [25] For example, silicone is used in Foley catheters where fractures have been reported, often requiring surgery to remove the tip left in the bladder.

Catheters used in interventional procedures

Depending on the mechanical characteristics required, assorted polymers and polymer-metal composites can be used to build catheters used for interventional purposes. Common materials include polyamide (nylon), polyether block amide, polyuerathane, polyethylene terephthalate, and polyimides. These materials are often used in combination with each other and are frequently layered on top of stainless steel braiding, laser-cut stainless steel tubing, or other scaffold-like structures to impart desirable handling characteristics to the catheter, all dependent on the intended application. For example, the materials and the architectures used to manufacture vascular catheters for neurological applications might differ significantly from catheters destined for cardiovascular use.

Guiding catheters (catheters that guides angioplasty balloons and stents) is made up of polytetrafluoroethylene (PTFE) innermost layer which is lubricious, followed by stainless steel braid wire outer layer which helps to provide support for the catheter and prevent kinking while travelling through blood vessels, and Nylon elastomer outermost layer which provides extra support for the catheter and preserve the curvature of the catheter while passing through tortuous vessels.[26]

To enhance ease of insertion, some catheters have a lubricious surface coating to lessen friction. A lubricious coating creates a smooth, slippery film making the catheter easier to insert.

Interventional procedures

Diagnostic catheters

There are various catheters used in angiography procedures. Diagnostic catheters[26] [27] direct wires through blood vessels. Radiocontrast agent is then injected through the catheter to visualise the vessels via various imaging methods such as computed tomography (CT), projectional radiography, and fluoroscopy.[27] Pigtail catheter is a non-selective catheter with multiple side holes that can deliver large volumes of contrast into a blood vessel for imaging purposes. Cobra catheter is a selective catheter used to catheterise downgoing vessels in the abdomen. Cobra catheters move forward by pushing and are removed by pulling.[28] Sidewinder catheter is a selective catheter is used to navigate the aorta.[29] Headhunter, Newton, Simmons, Bentson, and Berenstein catheters are used to navigate the into one of the three branches of the arch of aorta.[30] Yashiro Catheter is a selective, hydrophilic catheter designed for optimal entry into celiac trunk.[31] Whereas endothelial cell sampling through endovascular sampling with coils, stents, stent retrievers, or guidewires suffer from poor selectivity and a low or highly variable cell yield, a micro-3D-printed device adapted for endovascular techniques can harvest endothelial cells for transcriptomic analysis.[32]

Balloon catheters

See main article: Balloon catheter. There are also balloon catheters used in angioplasty procedures such as plain balloon catheters that is useful in passing tight vessel stenosis, drug coated balloons that contains paclitaxel on the surface to prevent smooth muscle cells proliferation of the vessel walls, thus reducing the likehood of vessel blockage in the future, high pressure balloons that can open stubborn vessel stenoses in veins and arteriovenous fistula, and cutting balloon angioplasty that contains 3 to 4 small blades on its surface (endotomes) that helps to control the distribution of balloon dilatation more uniformly and cut through resistant stenosis due to fibrous scar tissue.[33]

Dialysis catheters

See main article: Dialysis catheter. There is no difference in achieving adequacy of blood flow, period of catheter usage, infection, and thromboembolism risk whether the dialysis catheter has step-tip, split-tip, or symmetrical tip.[34] Palidrome catheter is superior to Permcath catheter in terms of maximum blood flow, dialysis adequacy, and annual patency rate. Similar to Permcath, Palidrome catheter has high infection and thromboembolism rate.[35]

Adverse effects

In interventional procedures, Teflon catheters (which are hydrophobic) have higher risk of thrombus formation when compared to polyurethene catheters. The longer the duration of the catheter left inside the body, the higher the risk of thrombus formation. Larger catheters increase the risk of thrombus formation around the catheter, because they can block the flow of blood.[36]

"Any foreign object in the body carries an infection risk, and a catheter can serve as a superhighway for bacteria to enter the bloodstream or body", according to Milisa Manojlovich, a professor at the University of Michigan School of Nursing.[37]

Catheters can be difficult to clean, and therefore harbor antibiotic resistant[38] or otherwise pathogenic bacteria.

See also

References

Notes and References

  1. Web site: catheter noun - Definition, pictures, pronunciation and usage notes | Oxford Advanced Learner's Dictionary at . Oxfordlearnersdictionaries.com . 2022-05-06.
  2. Book: Diggery, Robert . Catheters: Types, applications and potential complications (medical devices and equipment . 2012 . Nova Science . 978-1621006305.
  3. Altendorfer-Kroath. Thomas. Schimek. Denise. Eberl. Anita. Rauter. Günther. Ratzer. Maria. Raml. Reingard. Sinner. Frank. Birngruber. Thomas. January 2019. Comparison of cerebral Open Flow Microperfusion and Microdialysis when sampling small lipophilic and small hydrophilic substances. Journal of Neuroscience Methods. 311. 394–401. 10.1016/j.jneumeth.2018.09.024. 30266621. 52883354. 0165-0270.
  4. Schaupp. L.. Ellmerer. M.. Brunner. G. A.. Wutte. A.. Sendlhofer. G.. Trajanoski. Z.. Skrabal. F.. Pieber. T. R.. Wach. P.. Thomas Pieber. 1999-02-01. Direct access to interstitial fluid in adipose tissue in humans by use of open-flow microperfusion. American Journal of Physiology. Endocrinology and Metabolism. 276. 2. E401–E408. 10.1152/ajpendo.1999.276.2.e401. 9950802. 0193-1849.
  5. Ellmerer. Martin. Schaupp. Lukas. Brunner. Gernot A.. Sendlhofer. Gerald. Wutte. Andrea. Wach. Paul. Pieber. Thomas R.. 2000-02-01. Measurement of interstitial albumin in human skeletal muscle and adipose tissue by open-flow microperfusion. American Journal of Physiology. Endocrinology and Metabolism. 278. 2. E352–E356. 10.1152/ajpendo.2000.278.2.e352. 10662720. 11616153 . 0193-1849.
  6. Dragatin. Christian. Polus. Florine. Bodenlenz. Manfred. Calonder. Claudio. Aigner. Birgit. Tiffner. Katrin Irene. Mader. Julia Katharina. Ratzer. Maria. Woessner. Ralph. Pieber. Thomas Rudolf. Cheng. Yi. 2015-11-23. Secukinumab distributes into dermal interstitial fluid of psoriasis patients as demonstrated by open flow microperfusion. Experimental Dermatology. 25. 2. 157–159. 10.1111/exd.12863. 26439798. 34556907. 0906-6705. free.
  7. Kolbinger. Frank. Loesche. Christian. Valentin. Marie-Anne. Jiang. Xiaoyu. Cheng. Yi. Jarvis. Philip. Peters. Thomas. Calonder. Claudio. Bruin. Gerard. Polus. Florine. Aigner. Birgit. March 2017. β-Defensin 2 is a responsive biomarker of IL-17A–driven skin pathology in patients with psoriasis. Journal of Allergy and Clinical Immunology. 139. 3. 923–932.e8. 10.1016/j.jaci.2016.06.038. 27502297. 30272491. 0091-6749. free.
  8. Kleinert. Maximilian. Kotzbeck. Petra. Altendorfer-Kroath. Thomas. Birngruber. Thomas. Tschöp. Matthias H.. Clemmensen. Christoffer. December 2019. Corrigendum to "Time-resolved hypothalamic open flow micro-perfusion reveals normal leptin transport across the blood–brain barrier in leptin resistant mice" [Molecular Metabolism 13 (2018) 77–82]]. Molecular Metabolism. 30. 265. 10.1016/j.molmet.2019.11.001. 31767178. 6889745. 2212-8778.
  9. Urinary catheters: history, current status, adverse events and research agenda. Roger C. L.. Feneley. Ian B.. Hopley. Peter N. T.. Wells. November 17, 2015. Journal of Medical Engineering & Technology. 39. 8. 459–470. 10.3109/03091902.2015.1085600. 26383168. 4673556.
  10. Web site: MedlinePlus: Urinary catheters . 6 November 2019 . U.S. National Library of Medicine .
  11. Web site: MedTech Memoirs: Catheters . 16 June 2015 . Advantage Business Media . live . https://web.archive.org/web/20171024160847/https://www.mdtmag.com/blog/2015/06/medtech-memoirs-catheters . 24 October 2017 .
  12. Web site: Didusch Site - Milestones - Relief in a Tube: Catheters Remain a Steadfast Treatment for Urinary Disorders . www.urologichistory.museum . live . https://web.archive.org/web/20150117042240/http://www.urologichistory.museum/content/milestones/catheterization/p1.cfm . 2015-01-17 .
  13. Web site: Benjamin Franklin: In Search of a Better World . Minnesota Historical Society . dead . https://web.archive.org/web/20110812083821/http://benfranklinexhibit.org/resume . 12 August 2011 .
  14. Hirschmann, J.V. . December 2005 . Benjamin Franklin and Medicine . Annals of Internal Medicine . 143 . 11 . 830–4 . 10.7326/0003-4819-143-11-200512060-00012 . 16330795 . 32882591 . January 2, 2013 . https://web.archive.org/web/20191217033117/https://annals.org/aim/article-abstract/718880/benjamin-franklin-medicine . December 17, 2019 . dead .
  15. Huth, E.J. . Benjamin Franklin's place in the history of medicine . Journal of the Royal College of Physicians of Edinburgh . 37 . 4 . 2007 . 373–8 . 18447203 .
  16. Book: Baim, Donald . Donald S. Baim . Grossman's Cardiac Catheterization, Angiography, and Intervention . 2005 . Lippincott Williams & Wilkins . 978-0781755672.
  17. Smith . Reston N. . Nolan . Jerry P. . 2013-11-11 . Central venous catheters . BMJ . en . 347 . f6570 . 10.1136/bmj.f6570 . 1756-1833 . 24217269. 16939469 .
  18. Web site: The Nobel Prize in Physiology or Medicine 1956 . 2023-07-16 . NobelPrize.org . en-US.
  19. News: David S. Sheridan. 2004-05-07. Washington Post.
  20. Web site: David Sheridan, 95; Dropout Invented Key Medical Device. May 4, 2004. Los Angeles Times.
  21. Book: Engineers, NPCS Board of Consultants & . Handbook on Medical and Surgical Disposable Products . January 1, 2014 . Niir Project Consultancy Services . 9789381039281 . Google Books.
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  23. McKenzie . J. M. . Flahiff . C. M. . Nelson . C. L. . 1 October 1993 . Retention and strength of silicone-rubber catheters. A report of five cases of retention and analysis of catheter strength. . J Bone Joint Surg Am . en . 75 . 10 . 1505–1507 . 10.2106/00004623-199310000-00011 . 0021-9355 . 8408139 . dead . https://web.archive.org/web/20160923221049/http://jbjs.org/content/75/10/1505 . September 23, 2016 . May 12, 2016 .
  24. Agarwal . Shaleen . Gandhi . Mamatha . Kashyap . Randeep . Liebman . Scott . 1 March 2011 . Spontaneous Rupture of a Silicone Peritoneal Dialysis Catheter Presenting Outflow Failure and Peritonitis . Peritoneal Dialysis International . en . 31 . 2 . 204–206 . 10.3747/pdi.2010.00123 . January 31, 2024 . 0896-8608 . 21427251 . live . https://web.archive.org/web/20180508150819/http://www.pdiconnect.com/content/31/2/204 . 8 May 2018 .
  25. Mirza . Bilal . Saleem . Muhammad . Sheikh . Afzal . 14 August 2010 . Broken Piece of Silicone Suction Catheter in Upper Alimentary Tract of a Neonate . APSP Journal of Case Reports . 1 . 1 . 8 . 2218-8185 . 3417984 . 22953251.
  26. Ali . Ronan . Lecturer in Adult Internal Medicine, Faculty of Medical Sciences, University of the West Indies, St Augustine, Trinidad . Greenbaum . Adam B . Director, Cardiac Catheterization Laboratory, Henry Ford Hospital, Detroit, Michigan, US . Kugelmass . Aaron D . Chief of Cardiology and Medical Director, Heart and Vascular Program, Baystate Medical Center, 759 Chestnut Street, Springfield, Massachusetts, US. E: aaron.kugelmassmd@bhs.org . 2012 . A Review of Available Angioplasty Guiding Catheters, Wires and Balloons – Making the Right Choice . Interventional Cardiology Review . en . 7 . 2 . 100 . 10.15420/icr.2012.7.2.100 . 1756-1477.
  27. Web site: Themes. U. F. O.. 2016-06-20. Catheter-Based Technology and Devices. 2021-08-15. Thoracic Key. en-US.
  28. Web site: Bakal . CW . Flacke . S . Diagnostic Catheters and Guidewires . December 23, 2015 . Radiology Key . 3 February 2022 . https://archive.today/20220203112342/https://radiologykey.com/diagnostic-catheters-and-guidewires/ . 3 February 2022.
  29. Book: Davies . AH . Brophy . CM . Vascular surgery . 10 October 2005 . Springer Science & Business Media . 9781852332884 . 239 . 3 February 2022.
  30. Web site: Angiography peripheral intervention . Merit Medical . 4 February 2022 . https://web.archive.org/web/20210414170251/https://www.merit.com/wp-content/uploads/2014/09/PI-Angiography.pdf . 14 April 2021 . 21.
  31. Golowa . Yosef S. . Kalva . Sanjeeva P. . D'Othee . Bertrand Janne . April 2009 . Use of a Yashiro Catheter to Facilitate Complex Visceral Catheterization . Journal of Vascular and Interventional Radiology . en . 20 . 4 . 557–559 . 10.1016/j.jvir.2009.01.014. 19243973 .
  32. Sandell . Mikael . Chireh . Arvin . Spyrou . Argyris . Grankvist . Rikard . Al-Saadi . Jonathan . Jonsson . Stefan . van der Wijngaart . Wouter . Stemme . Göran . Holmin . Staffan . Roxhed . Niclas . Endovascular Device for Endothelial Cell Sampling . Advanced NanoBiomed Research . 21 August 2022 . 2 . 10 . 2200023 . 2699-9307 . 2699-9307 . 10.1002/anbr.202200023 . 251730092 . free .
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  35. Li M, Zhang Z, Yu Y, Chen H, Li X, Ma J, Dong Z . Clinical application of long-term Palindrome catheter in hemodialysis patients . Iranian Journal of Kidney Diseases . 8 . 2 . 123–9 . March 2014 . 24685735 .
  36. Formanek . Gustave . Frech . Robert S. . Amplatz . Kurt . May 1970 . Arterial Thrombus Formation During Clinical Percutaneous Catheterization . Circulation . en . 41 . 5 . 833–839 . 10.1161/01.CIR.41.5.833 . 0009-7322. free .
  37. Web site: Catheters: Big source of infection, but often overlooked . July 1, 2019 . Laura Bailey . . February 16, 2020.
  38. Web site: Nobody wants to talk about catheters. Our silence could prove fatal | Mosaic . Mosaicscience.com . 2018-11-07 . 2019-11-13.

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