Department of Biomedical Engineering, Tel-Aviv University, Tel-Aviv, Israel.
Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA.
J Cardiovasc Transl Res. 2021 Oct;14(5):883-893. doi: 10.1007/s12265-020-10096-3. Epub 2021 Jan 7.
Short peripheral catheters are ubiquitous in today's healthcare environment, enabling effective and direct delivery of fluids and medications intravenously. A commonly associated complication of their use is thrombophlebitis-thrombus formation-involved inflammation of the vein wall. A novel design of a very short peripheral catheter showed promising results in a pig model in reducing the mechanical irritation to the vein wall. Here, the kinetics of drug release through the novel catheter was compared to a standard commercial catheter using experimental and computational models. In a good agreement, in vitro and in silico models reveal the superiority of the novel catheter design with faster washout time, favorable spatial distribution within the vein, and substantially lower wall shear stress. We submit therefore that the novel design has an improved drug removal profile compared to the conventional catheter and can potentially reduce chemical irritation to the vein wall and minimize the risk for thrombophlebitis. CLINICAL RELEVANCE: Short peripheral catheters are ubiquitous in today's healthcare environment, allowing effective and direct delivery of fluids and medications intravenously. It is well known, however, that prolonged exposure to an irritant drug may lead to its absorption in the endothelial layer lining the vein wall, promoting among other, thrombophlebitis that may lead to increased morbidity, delayed treatment, and prolonged hospitalization. There have been multiple calls to consider low infusion rates with various infusion protocols and to place the catheter tip as central as possible to promote faster drug clearance and reduce the potential vessel damage, but the requisite device had not been available, and the short peripheral catheter is still, and for decades, the standard of care. Towards this end, we recently introduced a novel very short peripheral catheter design, and here, we demonstrate using experimental and computational models its favorable spatial and temporal drug-releasing profiles compared with the standard catheter. The clinically potential relevance is underscore both by the more efficient perfusion of IV drugs and lower irritation to the vein wall at the site of injection. Graphical abstract.
短外周导管在当今的医疗环境中无处不在，能够有效地将液体和药物直接静脉内给药。它们使用过程中常见的并发症是血栓性静脉炎-血栓形成-静脉壁炎症。一种非常短外周导管的新颖设计在猪模型中显示出有希望的结果，可以减少对静脉壁的机械刺激。在这里，通过新型导管的药物释放动力学通过实验和计算模型与标准商业导管进行了比较。体外和计算机模拟模型的良好一致性表明，新型导管设计具有更快的冲洗时间、在静脉内的有利空间分布以及显著更低的壁面剪切应力，因此具有优越性。因此，我们提出新型设计与传统导管相比具有更好的药物清除特性，可潜在减少对静脉壁的化学刺激，并最小化血栓性静脉炎的风险。临床相关性：短外周导管在当今的医疗环境中无处不在，允许有效和直接静脉内给药。然而，众所周知，长时间暴露于刺激性药物可能导致其在内皮层中吸收，促进其他并发症，如血栓性静脉炎，可能导致发病率增加、治疗延迟和住院时间延长。已经多次呼吁考虑使用各种输注方案降低输注率，并将导管尖端放置在尽可能中央的位置，以促进更快的药物清除并减少潜在的血管损伤，但所需的设备尚未出现，短外周导管仍然是并且几十年来一直是护理标准。为此，我们最近引入了一种新型非常短的外周导管设计，在这里，我们使用实验和计算模型证明了与标准导管相比，它具有有利的时空药物释放特性。静脉内药物灌注更有效和注射部位对静脉壁的刺激更小，突显了其临床潜在相关性。
