Medical

MAC, Cordis, Sheath Introducer – What’s The Difference?

As a cardiothoracic anesthesiologist and intensivist, I routinely place large central lines for resuscitation, vasoactive/inotrope administration, and to facilitate additional monitoring (ie, Swan Ganz catheter). Over the years, I’ve heard “MAC”, “sheath introducer”, “Cordis”, etc. used interchangeably but incorrectly. Let’s break these terms down!

SHEATH INTRODUCER

A “sheath” or “introducer” refers to any line (arterial or venous) that contains a port allowing a proceduralist to “introduce” (hence the name) transvenous pacing wires, Swan Ganz catheters, intravascular ultrasound (IVUS), intra-aortic balloon pumps, single lumen infusion catheters (“SLICs”), etc. The introducer lumen has a one-way diaphragm that prevents back bleeding and can often be capped with an obturator when not in use. The MAC and Cordis are two examples of venous introducers.

The following is a 9 French percutaneous sheath introducer (PSI).

Manufacturer: Arrow/Teleflex
Catheter: percutaneous sheath introducer (PSI)
Lumens: introducer + one infusion port

Compared to the 9 French MAC (see below), the PSI is shorter and therefore a better massive resuscitation line due to better flow rates as per Poiseuille’s Law. The big drawback is that it only has one side lumen.


MULTILUMEN ACCESS CATHETER (MAC)

Manufacturer: Arrow/Teleflex
Catheter: multilumen access catheter (MAC)
Lumens: introducer + two infusion port (brown distal, white proximal/side)

The brown lumen looks larger, so it makes sense that at baseline, it flows faster than the white lumen. When we take a closer look at the MAC’s flow rates, notice how if there’s a catheter inserted into the introducer (ie, a Swan-Ganz catheter), this steals real estate from the brown lumen and now makes the white lumen the faster flowing option. In this example, if the introducer is occupied with an 8 French catheter, the distal brown port’s flow is reduced from 33,000 mL/hr to 10,500 mL/hr making the proximal white port faster (13,000 mL/hr)! Always read your catheter’s flow rates as this can vary from one version to the next!

Even though this MAC is listed as 9 French in size, that’s only the case at the very distal tip of the catheter. Notice how as you move proximally, it quickly gets larger. Gotta make some room for that second infusion lumen!

MACs are placed with the dilator inserted through the introducer in one motion rather than sequential steps to facilitate the speed of placement. Once the MAC has been fully inserted, the dilator and guidewire are removed. This style of placement is the same for many introducers.


“CORDIS”

Manufacturer: Cordis (a Cardinal Health Company)
Catheter: AVANTI + Sheath Introducer
Lumens: introducer + one infusion port

Cordis AVANTI®+ Introducer (Image: Cordis.com)

“Cordis” is actually a company and the AVANTI introducer is the catheter name. Similar to the PSI above, this catheter has an introducer and one side port.

Drop me a comment with questions! 🙂

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2 Comments

    1. You can, but there isn’t a way to “lock” the CVC into the introducer since they’re not designed for such a purpose. There are specially designed catheters (ie, SLICs) which interface with the locking mechanism on the introducer and should be used instead.

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