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PubMed1996

Short- and long-term results with an active-fixation, bipolar, polyurethane-insulated atrial pacing lead.

Since 1989, 136 Medtronic 4058 and 4058M bipolar atrial screw-in leads have been implanted at the Mayo Clinic. Early lead related complications included dislodgment in 4 (2.9%). Over a median follow-up time of 14.4 months (1 day to 3.3 years), there were 11 lead related complications (undersensing, failure to capture, diaphragmatic pacing, and gross lead dislodgment). Chronic complications resulted in reoperations in four patients (2.9%). Of 77 patients in whom pacing thresholds were measured between 2 and 4 months after implantation, 9 (11.7%) and 2 (2.6%) had high pacing thresholds and very high thresholds, respectively. The Kaplan-Meier estimate of the probability of 1-year complication-free lead survival was 93.5%. There were no lead material failures. We conclude that the 4058/4058M lead implanted in the atrial position has favorable acute and chronic performance data, with a tendency toward high pacing thresholds at 3 months. The cause of this phenomenon and its course over time should be further evaluated.

Actuarial Analysis↗
PubMed2000

Adequacy of a new chlorhexidine-bearing polyurethane central venous catheter for administration of 82 selected parenteral drugs.

OBJECTIVE: To screen 82 commonly used parenteral medications for compatibility with a new chlorhexidine-bearing central venous catheter, the ARROWg+ard Blue Plus. Evaluations were performed for completeness of drug delivery and impact, if any, of the drugs on the amount of chlorhexidine removed from the internal lumens. DESIGN: Drug solutions were prepared in dextrose 5% injection or NaCl 0.9% at common concentrations. Three 10-mL aliquots of each drug solution were delivered over 10 minutes, one aliquot through each lumen of the triple-lumen catheter. The initial drug concentrations of the admixtures and the effluent samples were analyzed by HPLC for chlorhexidine content and for the amount of drug delivered relative to its initial concentration. RESULTS: The delivery of the infusion solutions alone through sample catheters resulted in no more than trace amounts of chlorhexidine in the solution. Background amounts ranged from < 2.5 to 6.1 micrograms/mL in the first 10 mL of solution. Administration of none of the drugs tested resulted in a substantial increase in chlorhexidine delivery. Furthermore, delivery of most of the drugs was at least 95% and usually was in excess of 97% of the initial concentration. Concentrations of five drugs, amikacin sulfate, cefoperazone sodium, cefotaxime sodium, cefepime HCl, and netilmicin sulfate were somewhat lower than the initial concentration (range 91-95%), but were still considered acceptable. CONCLUSIONS: The ARROWg+ard Blue Plus central venous catheter can be recommended for use with all of the 82 parenteral drugs tested.

Catheterization↗