Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Australia.
School of Engineering, The University of Western Australia, Perth, Australia.
Sci Rep. 2018 Feb 21;8(1):3441. doi: 10.1038/s41598-018-21617-1.
Peripheral intravenous catheters (PIVCs) are the most commonly used invasive medical device, yet up to 50% fail. Many pathways to failure are mechanistic and related to fluid mechanics, thus can be investigated using computational fluid dynamics (CFD). Here we used CFD to investigate typical PIVC parameters (infusion rate, catheter size, insertion angle and tip position) and report the hemodynamic environment (wall shear stress (WSS), blood damage, particle residence time and venous stasis volumes) within the vein and catheter, and show the effect of each PIVC parameter on each hemodynamic measure. Catheter infusion rate has the greatest impact on our measures, with catheter orientation also playing a significant role. In some PIVC configurations WSS was 3254 times higher than the patent vein, and blood damage was 512 times greater, when compared to control conditions. Residence time is geometry-dependent and decreases exponentially with increasing insertion angle. Stasis volume decreased with increasing infusion rate and, to a lesser degree, insertion angle. Even without infusion, the presence of the catheter changes the flow field, causing low velocity recirculation at the catheter tip. This research demonstrates how several controllable factors impact important mechanisms of PIVC failure. These data, the first of their kind, suggest limiting excessive infusion rates in PIVC.
外周静脉导管（PIVC）是最常用的侵入性医疗器械，但多达 50%的导管会失效。许多失效途径与机制有关，与流体力学有关，因此可以使用计算流体动力学（CFD）进行研究。在这里，我们使用 CFD 研究了典型的 PIVC 参数（输注率、导管尺寸、插入角度和尖端位置），并报告了静脉和导管内的血流动力学环境（壁面剪切应力（WSS）、血液损伤、颗粒停留时间和静脉淤滞量），并展示了每个 PIVC 参数对每个血流动力学测量的影响。导管输注率对我们的测量结果影响最大，导管方向也起着重要作用。与对照条件相比，在某些 PIVC 配置中，WSS 是正常静脉的 3254 倍，血液损伤是正常静脉的 512 倍。停留时间与几何形状有关，并随插入角度的增加呈指数下降。淤滞量随输注率的增加而减少，随插入角度的增加而略有减少。即使没有输注，导管的存在也会改变流场，导致导管尖端出现低速再循环。这项研究展示了几个可控因素如何影响 PIVC 失效的重要机制。这些数据是此类数据中的首例，提示在 PIVC 中限制过高的输注率。
