When I was starting my medical training, I had no idea what the difference was between a Cordis and a MAC introducer. I used to hear these words called out in an emergency situation as follows:
Quick! We need to resuscitate this patient with blood STAT! Call for the massive transfusion protocol and grab me a Cordis STAT!
Do you know what this means?
Do you know what it means if they asked for an introducer?
As mentioned, for many years I was confused myself. I mean, aren’t they both just large bore central lines for the purpose of infusion blood quickly or floating a central line? Well yes, they are. But depending on what institution you work at, you may get a funny look on your face if you ask for it by the non-standard name. Non-standard for that institution, of course. I will make this clear, though, as I posted this earlier in the life of my Instagram page.
You can get A LOT done in a massive bleed with two solid 16 gauge peripheral IVs. Many times you do not need an off the shelf triple lumen central line. But there are times when patients mean business and they needs the best and a catheter of this type is necessary. Okay, let’s start.
The two devices that I am mentioning here are primarily designed to be placed in the femoral vein or the internal jugular vein.
You may ask what is a MAC introducer? A MAC introducer is a proprietary product from Arrow/Teleflex. MAC is a trademarked name that stands for multi-lumen access catheter. You may say to yourself, well Eddy, a triple lumen catheter should be a MAC line too! You’re not wrong, but we can’t make this already challenging job easier on ourselves, right? MAC introducers can come with anywhere from one to three lumens, hence the name Multi-lumen Access Catheter. It is a type of central line.
You could float a swan or transvenous pacer through many MACs, but not all. It is essentially like a “Cordis” but it could have another lumen. The MAC also has the dilator in the catheter which I personally like because you don’t have to run the dilator over the wire first and then run the catheter over it. It removes one step which is great in an emergency resuscitation scenario.
You may ask, what is a Cordis? A Cordis is also an introducer, but the word “Cordis” is the name of the company. We use the word “Cordis” colloquially but it really means the AVANTI+ sheath introducer. No one, at least to my knowledge, says “grab me an Avanti”!
A Cordis is the same sheath introducer, but only has one side port. It is purely a single-lumen device. You can also float a swan ganz catheter, also known as a PA catheter, or a transvenous pacer through this puppy. This also is a type of central line. It provides central access. Cardinal Health parent company of Cordis.
What size is a Cordis?
A Cordis/AVANTI comes in many sizes. For the sake of rapid infusion, the sizes go from 8-11 french. There are two lengths of the large-bore cannula: 11cm and 23cm. The former being for IJ access and the latter for femoral access. More information regarding the sizes can be found on their order form here.
The Cordis has a flow rate of 126cc/min but with a pressure bag that could increase to 333cc/min. That means that a liter of fluid can be infused in 8 minutes and 3 minutes respectively.
There are other manufacturers who make similar products that I am not going to cover here for the sake of time. Your friendly neighborhood ICU should have one of these introducers in stock. Familiarize yourself with where it is because the day you need it, the patient NEEDS it. Next time you are curious about the differences between a cordis and a mac introducer, you’ll know. When someone yells “cordis” or “mac introducer”, you’ll know.
Photo credits for Arrow/Teleflex Products
Photo credits for Cordis Products
Copyright gods: If the photos posted upset you, let me know and I will take them off. Just trying to teach here.
I have posted many articles on resuscitation and fluid responsiveness that you can check out HERE.
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Reel Script for Cordis vs. MAC Introducer
Patient is in hemorrhagic shock and actively bleeding.
Their peripheral access is garbage, we need to activate the massive transfusion protocol.
Depending on your institution, you might hear someone call out “grab me a Cordis, please” or you might hear someone says “grab me MAC introducer, please”.
Outside of massive transfusion protocols, other indications include floating a PA catheter, transvenous pacing, and rapid infusion of fluids. Let me know what other indications I may have missed in the comment section below.
This content is to teach you the difference between the two.
Let’s cover the Cordis first.
It may be hard to believe but Cordis is the name of the company, not the actual catheter.
Cordis makes the AVANTI sheath introducer.
This introducer typically has one lumen that depending on the French size.
One lumen to infuse fluids may not be enough. Enter the MAC introducer.
The MAC introducer is made by Arrow/Teleflex.
MAC stands for multi-access lumen catheter.
These typically have two access channels: a proximal and distal, but could have more than two.
Which of these two do you have at your institution?