Positioning the right atrial catheter: a model for reappraisal.

A flexible Silastic casting of the human right atrium was developed to correspond to some in vivo human right atrium hemodynamic characteristics including chamber pressures, pulsatility, fluid output, and flow velocity. Using an infusion pump, air was introduced (10 ml in 30 s) into the superior vena cava of the model and aspirated via a catheter from different positions within the model atrial chamber. The tests were carried out at atrial inclinations of 60 degrees, 80 degrees, and 90 degrees from the horizontal and compared the aspiration efficiency of a single-orificed 16-gauge catheter to a 16-gauge multiorified (5 aperatures) catheter. Optimal air aspiration occurred with the multiorificed catheter tip positioned within the area 2.0 cm below the junction of the superior vena cava (SVC) and the atrial chamber at an inclination of 80 degrees. As much as 80 per cent of the incoming air could be aspirated under these conditions. At its optimal position the single-orificed catheter gave a maximal yield of 45 to 50 per cent aspiration when the tip was positioned 3.0 cm above the SVC and atrial chamber junction. Aspiration of air from mid right atrium (4.5 cm below the SVC-atrial junction) was poor regardless of the type of catheter used or atrial inclination. These data suggest a need for reappraisal of catheter design and placement.