BACKGROUND: Pyrogen reactions are triggered by intravenous injection of fluids or medications contaminated by bacterial endotoxins. Despite its low incidence, it must be investigated and eliminated, as it may be harmful to the patient and reflects the quality of the catheterization laboratory. METHODS: Prospective study to evaluate patients undergoing diagnostic or therapeutic percutaneous coronary procedures who develop pyrogen reactions. This group was compared with a historical cohort of patients undergoing invasive procedures with no pyrogen reactions. The possible causes of pyrogen reactions were established based on the use of a check-list protocol. RESULTS: From September 2008 to February 2009, 25 (2.4%) of 1,026 percutaneous coronary procedures were associated to pyrogen reactions. Radial access was used in all cases, and the procedures were characterized by the use of recyclable materials. Technical aspects, fluids, storage and packaging conditions of the materials, possible changes in the routine of in-house service providers were investigated and the source of pyrogen reactions was not identified. The higher frequency of reusable catheters in the group with pyrogen reactions indicated a possible relationship with the water used to flush catheters in the final step of the sterilization process. Pyrogen reactions were no longer observed after replacement of a component of the water filter. CONCLUSIONS: The use of investigation protocols is an important tool in the identification and eradication of sources of pyrogen reactions.
Catheterization; Pyrogens; Endotoxins; Water microbiology; Water purification; Equipment reuse; Equipment contamination
