Pyrogen Reactions from Cardiac Catheterization

¹ Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn.

Most nonspecific febrile reactions resulting from intravenous injection of fluids, medications, or catheterization, have been determined to be due to bacterial endotoxins. These lipopolysaccharides are heat-stable, water-soluble and relatively resistant to many chemicals. An epidemic of pyrogen reactions in patients receiving cardiac catheterization at our institution appeared to be related to contamination of the catheters with endotoxin, presumably present in the tap water used for cleaning. Ethylene oxide at 50-60° C was found to be incapable of inactivating endotoxin. Endotoxin placed in the catheters, as well as the epidemic of pyrogen reactions, was eliminated when copious amounts of pyrogen-free water (1,000 ml) were used as a final step in cleaning each of the catheters before gas sterilization.