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407

Influence Efficiency Drainage

of the Stopcock of Percutaneous Catheters:

Laboratory

Evaluation

on the

.

Horacio

B. D’Agostino1 Yong Park1 J. Philip Moyer&

Eric

2

Robert

Brian

B. Sanchez1

W. Goodacr& Yun

Marcelo

Hwan

Vasconcellos

Kim1

Vieira1

.

The effects of stopcocks on percutaneous fluid drainage were tested in a laboratory model by using a standard stopcock (6-French inner diameter) and a prototype stopcock (9-French inner diameter) connected to 8-, 10-, 12-, 14-, and 16-French catheters. Catheters were immersed in water alone or in viscous fluid with particulate matter, and the system was connected to low wall suction or gravity drainage. The average volume of fluid aspirated in a given period with and without a stopcock was compared for each catheter. The standard stopcock decreased drainage efficiency for these catheters by

13-42%. This decreased drainage efficiency was worse with the larger catheters. Particulate fluid blocked the stopcock connection for all catheters. With the prototype stopcock, drainage of water alone was reduced by 0-9% for the catheters of different sizes. Particulate fluid did not obstruct the prototype stopcock with any size catheter. With gravity drainage, the volume of water aspirated was reduced by 12-42% with the standard stopcock and by 3-6% with the prototype stopcock. These data suggest that stopcock connections greatly influence the efficiency of the percutaneous drainage systems. Stopcocks with larger inner diameters may improve drainage over that achievable with the stopcocks that are currently available. AJR

159:407-409,

Percutaneous

August

catheter

1992

drainage

systems

include

a three-way

stopcock

and a

connecting tube attached to suction or to a drainage bag. Stopcocks are used routinely, regardless of the indication for drainage or the type and size of catheter. Irrigation of the catheter through a stopcock maintains the catheter’s patency, and it decreases the risk of occlusion and secondary bacterial contamination of the drainage system [1]. Additionally, the use of a stopcock prevents spillage of fluids while the catheter is being flushed, allowing isolation of body substances, one of the basic universal precautions. Reduction offlow or obstruction of catheters and stopcocks by particulate matter or stone fragments can hinder drainage of abscesses, biliary or urinary [1 3-5]. To address these problems, we assessed the effect of the stopcock on the efficiency of catheter drainage systems in an experimental model. We report the results of this study, discuss its potential impact, and recommend ways to improve the efficiency of drainage via catheters. ,

Received November 20, revision February 24, 1992. 1

Department

of Radiology,

1991

;

accepted

after

University of Califor-

nia, San Diego, CA 92093. Address reprint requests to H. D’Agostino, Department of Radiology (H-756), UCSD Medical Center, 225 Dickinson St., San Diego, CA 92103. 2 Department of Medicine, Division of Gastroen-

terology, University Jolla, CA 92093.

of Califomia,

0361 -803X/92/1 592-0407 C American Roentgen Ray Society

San Diego, La

Materials

and Methods

The experimental model used French; length, 20 cm) and sump

both single-lumen catheters (sizes

drainage catheters (sizes 8- and i 0i 2-, i4-, and i6-French; length, 30 cm)

(Medi-tech, Watertown, MA). The inner diameter and the number and size of drainage holes for each catheter are given in Table i Although double-lumen catheters of sizes i2- to i6French were used, the sump port was occluded so that we could better address the influence .

of the stopcock as the sole variable in a single-lumen system. In the first phase of the experiment, a standard stopcock with a 6-French

(Baxter,

Irvine, CA) was connected

in series to both the catheter

inner

and continuous

diameter

low wall

D’AGOSTINO

408

AJA:159,

Catheter

Suction

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ET AL.

I

1992

Fig. 1.-A and B, Diagrams of a stopcock drainage system show standard stopcock with 6-French inner diameter (A) and prototype stopcock with 9French Inner diameter (B). Three-way stopcock is shown longitudinally and in cross section (third opening has been

Suction

6-French

August

eliminated

9-French

for clarity).

9french

A

B

TABLE

1: Characteristics

Catheter

Size

of Catheters

Inner Diameter

TABLE 2: Comparisons of Average and Without Standard Stopcock

Studied

Number

of Holes

Catheter Size (French)

Size of Holes

(mm)

(French)

(mm)

8 io

i.5

5

2xi

2.3

4

3x2

i2

2.3

5

4x2

i4

2.8

5

5x2

16

3.6

5

6x2

was

trials.

removed

drained

The experiment

from

by each catheter,

compared,

was repeated

the drainage both

io 12 i4 i6

experiment,

i4

below

the fluid

level.

The

volumes

stopcock, with the standard stopcock, cock were measured and compared.

catheter

of fluid

drained

without

and with the prototype

standard solution

volumes

stop-

with and without

stopcock performance for all catheters for draining water alone, ranging from a decrease of 13% for 8-French catheters to a decrease

particles

in one of three trials for 8-French

was

TABLE

3: Comparison

Without Prototype

.

Stopcock

Catheter Size (French)

not

13 26 25 30 42

Fluid i6

-

53

-

43

-

66

-

i 20

-

calculated

of Average

for

Volume

particulate

fluid

Aspirated

because

of

with and

Stopcock Volume Aspirated

With Stopcock

(ml)

Without

Stopcock

.

Drainage Difference (% decrease)

Water

i2 i4

i8i 396 380 460

i83 396 383 490

i6

563

6i6

8

a

stopcock for both water and particulate viscous are shown in Table 2. Incorporating a standard into the drainage system caused a decrease in

When stopcock

difference

at stopcock.

io

of fluid aspirated

of 42% for 1 6-French catheters. fluid was drained, the standard

Drainage

occlusion

a

Results

The average

i6

the two

drainage system was used with a prototype stopcock that had a 9French inner diameter (Cook, Inc., Bloomington, IN) (Fig. 1B). As in the first phase, the average volumes drained with each catheter with and without the stopcock were compared, and the percentage of the difference between the two volumes was calculated. These experiments were repeated with gravity drainage instead of low wall suction. Catheters were again immersed in water and in viscous fluid with particles. The collection container was placed 20 cm

i2

were

between

an identical

with

Drainage Difference (% decrease)8

i83 396 383 460 6i6

Occludedini of 3 trials Occludedin2 of 3 trials Occludedin3 of 3 trials Occluded in 3 of 3 trials Occluded in 3 of 3 trials

io

a

of the

Without

Particulate 8

volumes

the stopcock,

of the difference

With Stopcock

(ml)

Aspirated

Water

after the stopcock

The average

with and without

and the percentage

volumes was calculated. In the second phase

system.

Aspirated

i60 290 286 320 356

8

suction (50 mm Hg) (Fig. i A). Each catheter was immersed in water alone and then in particulate viscous fluid for three trials of i mm each. The particulate viscous fluid was prepared by mixing water and ultrasound gel (3:2 v/v mixture) with i 0 g of crumbled white bread. The particles of bread were 1-5 mm in size, and the viscosity of the solution was 135 centistokes. The average volumes of the water and the particulate fluid drained with each catheter were noted for each of the three

Volume

Volumes

Particulate

Influence of the stopcock on the efficiency of percutaneous drainage catheters: laboratory evaluation.

The effects of stopcocks on percutaneous fluid drainage were tested in a laboratory model by using a standard stopcock (6-French inner diameter) and a...
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