![]() ![]() ![]() Shelly Rainforth Collins PharmD, BCGP, in Gahart's 2022 Intravenous Medications, 2022 RA: Radium is not metabolized by the body it only decays radiologically over time. Radium is like calcium in that it deposits in bones and teeth when taken into body. Intentional uses of radium today are primarily in the treatment of cancer using a radiation source and as a neutron source in research and instrument calibration. Virtually everyone is exposed to low levels of radium in inhaled air and ingested water and food. The radioactive properties of radium are the greatest concern and overwhelm all else. Radium is almost ubiquitous in soils, water, geologic materials, plants, and foods at low concentrations. Radium is a silvery-white radioactive metal found in most soils and rocks, although usually present in small quantities. Radium, CASRN, has a particularly interesting history it was isolated from pitchblende by the Curies in 1898, who in 1903 jointly won the Nobel Prize in physics for their studies of radiation. ![]() Gad, in Encyclopedia of Toxicology (Third Edition), 2014 Abstract Disadvantages include the need for regular maintenance and the potential for unacceptable cosmesis. Advantages of an RA catheter include ease of insertion and use, minimal interference with patient activity, low incidence of major complications or unintended dislodgment, ease of removal, and potential repair via a kit. 14 However, no study has been able to support this belief. Dacron cuffs (one near the venous entrance site and one near the skin exit site) anchor the catheter and are believed to inhibit colonization of the SVC by skin organisms. The subcutaneous tunnel isolates the venous puncture site from the skin and decreases the potential for bacterial contamination. 24.2), advancing the distal tip of the flexible catheter to the distal SVC or into the mid-RA area. The device is introduced via the arm, upper anterior chest wall, or neck, and tunneled subcutaneously to enter the superior vena cava (SVC) system via the cephalic, subclavian, internal, or external jugular vein ( Fig. Nonemergency insertion of RA catheters is typically done in an operating room or interventional radiology suite. They are not recommended for long-term access in patients undergoing dialysis if an AV fistula or graft ( Video 24.2 ) is possible, as long-term dialysis with tunneled catheters has been associated with an increased risk for death, a five- to tenfold increase in the risk for infection, and a decreased likelihood of adequate dialysis. The main advantage of these catheters is that they can be used immediately as a bridge to longer-term devices. Quinton Instrument Company (Bothell, WA) manufactures these catheters for HD, plasmapheresis, long-term nutritional support, and pain control. Hemocath/Permacath has the largest bore of the RA catheters, with an ID of 2.2 mm. 12 Single-, double-, and triple-lumen variations exist. It allows more frequent blood sampling without jeopardizing luminal patency. The Hickman (Bard), also a Silastic catheter, has a 1.6-mm ID. It is 90 cm long with a thin intravascular segment (55 cm). The Broviac (Bard Peripheral Vascular, Tempe, AZ) is an all-Silastic, single-lumen catheter, with a 1.0-mm internal diameter (ID). Several cuffed, tunneled RA catheters are available, each with differences tailored to specific applications ( Fig. Roberts MD, FACEP, FAAEM, FACMT, in Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care, 2019 Cuffed, Tunneled Right Atrial (RA) Catheters (Broviac, Hickman, Hemocath, Leonard, Raaf) ![]()
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