Never Thread a Triple-Lumen through a Cordis
Bradford D. Winters MD, PhD
Introducer catheters (i.e., Cordis catheters) are used for the placement of devices, such as pulmonary artery catheters (PACs) and certain cardiac pacing devices as well as when extremely large volume resuscitations are needed or anticipated. Since PACs and pacers may need frequent manipulation of their position, they are placed through the hemostatic valve of the Cordis, which holds them in position and prevents back leakage of blood. Different devices require and are matched to different sizes of Cordis catheters and it is imperative that the device is appropriately matched to the Cordis diameter. Occasionally, practitioners will place a standard central line catheter through the Cordis when one of the aforementioned functions is not applicable. Despite it seeming reasonable to do so, standard single-, double-, and triplelumen central venous access catheters should not be placed through a Cordis for several reasons.
Watch Out For
First, standard single-, double-, and triple-lumen central venous access catheters are not designed to fit the cordis and so there is the risk of back leakage of blood. There is also the risk of air leakage around the hemostatic seal, leading to air emboli. Additionally, pulmonary artery catheters and pacers have sheaths that are designed to cover them so that when their position is manipulated, the catheter remains sterile so as not to introduce microorganisms into the bloodstream. Central line catheters are not designed for use with these sheaths. The port in the cordis needs to be kept covered and sterile with the sheath or an appropriate locking cap. Central line catheters are not configured in this manner and should not be jerry-rigged with one. Placing a standard central line catheter with any number of lumens through a Cordis creates an infection risk.