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Easy as Pi? Why geometry might save us from tough percutaneous catheter insertions

Easy as Pi? Why geometry might save us from tough percutaneous catheter insertions Many percutaneous catheters require a skin and subcutaneous tissue incision for insertion. Sizing the incision has important consequences. An incision that is too small may risk greater force for insertion, slow insertion, procedure failure, medical device damage (such as kinking or cracking of a catheter), or injuries such as vascular dissection or perforation. An incision that is unnecessarily large may result in bleeding, poor cosmetic outcomes, or prolonged healing.The size of the insertion site incision is not specified for commonly used devices1,2 or may have an inadequate basis. A widely used textbook of emergency procedures advises “Make the incision the width of the catheter”3 while another core text recommends “Incise the skin … to accommodate the venodilator or catheter.”4 Yet another source calls for “a small nick in the skin … approximately 0.5 cm in width,” without reference to the size of the device to be inserted.5These recommendations overlook geometry, which can be used to calculate the incision length for a circular catheter inserted at a right angle to skin, assuming conditions of no tissue stretch. The nonintuitive results (Figure 1) show that the incision length required for a stretch‐free insertion is not the catheter diameter, as recommended by one http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Academic Emergency Medicine Wiley

Easy as Pi? Why geometry might save us from tough percutaneous catheter insertions

Broder, Joshua Seth
Academic Emergency Medicine , Volume 30 (10) – Oct 1, 2023
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References (6)

Publisher
Wiley
Copyright
Copyright © 2023 Society for Academic Emergency Medicine
ISSN
1069-6563
eISSN
1553-2712
DOI
10.1111/acem.14748
Publisher site
See Article on Publisher Site

Abstract

Many percutaneous catheters require a skin and subcutaneous tissue incision for insertion. Sizing the incision has important consequences. An incision that is too small may risk greater force for insertion, slow insertion, procedure failure, medical device damage (such as kinking or cracking of a catheter), or injuries such as vascular dissection or perforation. An incision that is unnecessarily large may result in bleeding, poor cosmetic outcomes, or prolonged healing.The size of the insertion site incision is not specified for commonly used devices1,2 or may have an inadequate basis. A widely used textbook of emergency procedures advises “Make the incision the width of the catheter”3 while another core text recommends “Incise the skin … to accommodate the venodilator or catheter.”4 Yet another source calls for “a small nick in the skin … approximately 0.5 cm in width,” without reference to the size of the device to be inserted.5These recommendations overlook geometry, which can be used to calculate the incision length for a circular catheter inserted at a right angle to skin, assuming conditions of no tissue stretch. The nonintuitive results (Figure 1) show that the incision length required for a stretch‐free insertion is not the catheter diameter, as recommended by one

Journal

Academic Emergency Medicine – Wiley

Published: Oct 1, 2023

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