Cotton fiber embolization can occur during cardiovascular, neurovascular and peripheral vascular interventions, which can cause patient complications. To increase the safety of interventional procedures, it is important to eliminate cotton-based products from the procedural workflow.
Based on input from cardiac catheter labs and interventional radiology departments, Cardinal Health has implemented pack design changes, such as placing all-cotton linting components like operating room towels and gauze into zip-lock bags. The company also introduced new products from Syntervention like the Swiper®, a medical-grade foam wipe to clean particulate and fiber from guidewires and catheters before insertion into patients' arteries surrounding the heart.
Becker’s Hospital Review recently spoke with John Laird, MD, about the risks associated with cotton fiber in cardiology procedures and his organization's adoption of the Swiper. Dr. Laird is an interventional cardiologist and medical director of the Adventist Heart and Vascular Institute in Saint Helena, Calif.
Note: Responses have been edited for length and clarity
Question: What are the risks related to fiber and lint in interventional procedures?
John Laird: I have been a practicing interventional cardiologist for over 30 years. As part of my clinical practice, I perform percutaneous coronary artery interventions, structural heart interventions and the full spectrum of extracardiac vascular interventions.
Over the years I have seen complications related to fiber and lint contamination and infection following interventional procedures in the cath lab. As the complexity of procedures increases and as we treat higher-acuity patients, the possibility of complications will only grow.
Q: Why is it important to minimize the use of cotton-based components in the cath lab and IR space?
JL: It is amazing that in 2021, cardiac cath labs and IR suites continue to use cotton-based products as part of diagnostic and interventional procedures, particularly given the history of complications related to fiber and lint contamination during these procedures.
Cotton fibers are highly thrombogenic. When shed from towels and cotton gauze and introduced into the blood stream, they lead to thrombus formation and arterial occlusion. This is particularly devastating in the coronary and cerebral vasculature where stroke and myocardial infarction have been reported following cotton fiber embolization. When cotton fibers are deposited in tissues, they are highly inflammatory, leading to granuloma formation and an increased risk of infection.
Q: What is the biggest contributor to particulate and fiber in the cardiac cath lab and how can it be prevented?
JL: The biggest contributors are: 1) the ubiquitous cotton gauze products used to absorb blood and wipe off catheters and guidewires during procedures; and 2) the cotton towels that are a universal component of the sterile field in cath labs, IR suites and operating rooms. Cotton fibers are shed from these products and attach to fingers, guidewires, and catheters and can be introduced into the body.
The simple way to prevent this problem is to remove cotton-based products from cath lab and IR packs and replace them with low-lint options. The time is long past to rid cath labs and IR suites of these cotton-based products.
Q: What is the rationale behind your hospital's adoption of the Swiper medical-grade foam wiper?
JL: The Swiper is a well-designed product that seamlessly replaces cotton gauze in interventional procedures. The obvious advantage is that it is a low-lint alternative to cotton gauze. The Swiper is also effective in removing blood, contrast, and other debris from catheters and wires, and is highly absorbent.
The cath lab staff has embraced this low-lint alternative and recognizes the benefits of Swiper over cotton gauze when wiping debris off guidewires. Swiper is very effective for hydrating hydrophilic surfaces. It can be used over and over again during procedures, reducing the amount of product required in the cath pack and during procedures.
We have also introduced the Swasher® lint-free towel into the cath packs at our hospital. The blue and green cotton towels historically used in cath labs and IR suites are notorious shedders of lint. We have seen this during long and difficult procedures where cotton fibers and lint end up all over a clinician's gloves. Hydrophilic catheters and guidewires that lie on these cotton towels pick up fibers, particularly as they dry. If the fibers are on one's gloves or are adherent to catheters or guidewires, they will ultimately end up in the patient, which is what we are trying to prevent.
Q: In addition to those outcomes, are there any other patient benefits you've noticed?
JL: There are benefits for patients and for the hospital. Reducing vascular complications and infections are key to providing the best care for our patients and to reducing hospital costs. Another benefit of the Swiper is that it is reusable during the procedure and will provide added procedural efficiency and reduced waste.