INTRODUCTION: HISTORY
Clinicians have been injecting substances into veins since the 17th century. The first techniques relied on feather quills, animal veins and animal bladders. One of the earliest practitioners was Sir Christopher Wren, who injected opium and wine into the veins of dogs in 1656. In 1662, the technique was applied to humans by J.D. Major.
History credits Jean Baptiste Denis with the first documented blood transfusion. In this initial transfusion, Denis injected 9 ounces of lamb blood into a 15-year-old boy with mental illness. The transfusion initially worked and became a popular procedure. However, the boy eventually experienced the first transfusion reaction. Several other transfusion recipients died, causing the church and the French parliament to ban animal-to-human blood transfusions in 1687 (1).
More than 100 years later, James Blundell performed the first human-to-human blood transfusion. Researchers spent the following years trying to eliminate the coagulation problems caused by mismatched blood types. During a cholera epidemic in the 1830s in Scotland, physicians experimented with administering saline to patients; this procedure appeared to save some patients. Years later, Stanley Dudrick improved the procedure even further, showing in experiments with beagles that it was possible to parenterally support all nutritional needs (1).
Doctors began to administer intravenous therapy to humans via central venous catheters (CVCs) in the 1950's. Since then, many changes to the equipment have been implemented, and additional steps have been added to ensure the safety of both the patient and the practitioner. The first of many introductions occurred in 1977, following the 1976 Post-Graduate Assembly in Anesthesiology in New York City. Arrow International representatives met with Dr. Jacob Israel of Columbia University Medical Center. Doctors were looking for a sterile catheter insertion "tool kit" to bring all the components necessary for a CVC insertion into one package. The initial CVC insertion kit was soon introduced. It included a prep sponge, syringe, two needles, a guidewire and a single lumen catheter.
Several evolutions in CVC procedures and technology occurred over the next twenty years. These included the development of the first biocompatible polyurethane CVC and the introduction of the first multi-lumen CVC to improve access for multiple infusions or monitoring while reducing the risk of catheter occlusions. Following these changes, additional tools and design changes were introduced by Arrow International to aid in the reduction of complications such as pericardial effusions and cardiac tamponade. Arrow added the Blue FlexTip® to all their central venous catheters. In 1992 the first antimicrobial catheter, ARROWg+ard Blue®, a Chlorhexidine-based technology, was introduced to prevent catheter-related infections on the extraluminal surface of the catheter (2).
Further procedural safety began in 1984 with the use of ultrasound to guide CVC placement. Two years later, doctors performed the first real-time ultrasonography, used to visualize the target vein and nearby anatomical structures.
