Incidence of the Curvature of a Catheter on the Variations of the Inner Volume: Application to the Peripherally Central Catheters (original) (raw)
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Characterization of Catheter Dynamics During Percutaneous Transluminal Catheter Procedures
IEEE Transactions on Biomedical Engineering, 2009
Remote catheter navigation systems are being developed to reduce the occupational risk of the intervening physician. Despite the success of such systems, development has occurred with little fundamental knowledge of the catheter dynamics applied by the interventionalist. This paper characterizes the kinematics of a catheter during manipulation, the minimum applied force/torque during interventional procedures, and the maximum force/torque applied by an operator to overcome vasculature friction. Ten operators manipulated a 6F catheter inside a specialized catheter movement sensor to determine the velocities and accelerations of catheter motion. A mass-spring apparatus was constructed to measure the forces and torques required to overcome introducer sheath and vasculature friction. Results showed the catheter was manipulated at peak velocities and accelerations of (µ ± σ) : 360 ± 180 mm·s −1 and 22200 ± 14000 mm·s −2 , and 19 ± 7 rad·s −1 and 900 ± 510 rad·s −2 , for axial and radial directions of motion, respectively. A minimum force of 0.29 ± 0.06 N and a torque of 1.15 ± 0.3 mN·m was required to move the catheter through the introducer sheath; while the observed maximum applied torque was 15 mN·m to overcome vasculature friction. The implications of these results for future design optimization of an intuitive remote catheter navigation system are considered.
Influence of arm movement on central tip location of peripherally inserted central catheters (PICCs)
Pediatric Radiology, 2006
Background: PICCs are increasingly employed in children. Some of their risks relate to the location of the central tip. Despite care when placing lines, they sometimes move. Objective: To evaluate the influence of arm movement on the central tip location of PICCs placed in children. Materials and methods: The central tip location of PICCs was studied in 85 children, with the arm placed in six positions. The variables of side, vein, site and arm position were examined to measure the direction and range of tip movement. Results: The side, site or vein used did not influence the range of movement of the central tip. Change in position of the arm had a significant influence on the central tip location, moving it an average of 2.2 rib spaces, a maximum of 3.5 ribs. Elbow bending and adduction of the arm caused the central tip to move deeper into the chest, compared to when the arm was straight and abducted 90°. Conclusion: Arm position is the significant variable influencing PICC movement. Side, site and vein do not influence the range of movement significantly. Most PICCs descend deeper into the chest with arm adduction and elbow bending.
2010
Background: Early goal directed therapy improves survival in patients with septic shock. Central venous pressure (CVP) monitoring is essential to guide adequate resuscitation. Use of peripherally inserted central catheters (PICC) is increasing, but little data exists comparing a PICC to a conventional CVP catheter. We studied the accuracy of a novel PICC to transmit static and dynamic pressures in vitro. Methods: We designed a device to generate controlled pressures via a column of water allowing simultaneous measurements from a PICC and a standard triple lumen catheter. Digital transducers were used to obtain all pressure readings. Measurements of static pressures over a physiologic range were recorded using 5Fr and 6Fr dual lumen PICCs. Additionally, random repetitive pressure pulses were applied to the column of water to simulate physiologic intravascular pressure variations. The resultant PICC and control waveforms were recorded simultaneously. Results: Six-hundred thirty measurements were made using the 5 Fr and 6 Fr PICCs. The average bias determined by Bland-Altman plot was 0.043 mmHg for 5 Fr PICC and 0.023 mmHg for 6 Fr PICC with a difference range of 1.0 to-1.0. The correlation coefficient for both catheters was 1.0 (p-value < 0.001). Dynamic pressure waveforms plotted simultaneously between PICC and control revealed equal peaks and troughs. Conclusion: In vitro, no static or dynamic pressure differences were found between the PICC and a conventional CVP catheter. Clinical studies are required to assess whether the novel PICC has bedside equivalence to conventional catheters when measuring central venous pressures.
research article, 2024
Background: Phlebitis is still a common complication of peripheral venous catheters. Finding a suitable solution to prevent and reduce the incidence of this complication continues to be a challenge. Various strategies were used to reduce the incidence of phlebitis. Mostly non-pharmacological measures were taken as first preference. Intially, when patients come to any hospital for their treatment, the first is the peripherally inserted venous catheter access conducted inpatient for medication administration, fluid administration and blood transfusion in both the hospital setting and ambulatory setting. About 70% of thepatients admitted to the hospital requires peripherally inserted venous catheters (PIVCs). The incidence of phlebitis is higher in patients who undergo continuous intravenous therapy. Objectives: To find out the effect of hand grip exercise in the sustaining patency of peripherally inserted venous catheters among patients in continuous intravenous therapy. Methods: During the 8 weeks the hand grip exercise was evaluated in patients, who had undergone continuous intravenous infusion through the peripherally inserted venous catheter for at least 3 days. The measurement of data is based on the patient's socio-demographic Performa, patency checklist, visual infusion phlebitis score and visual analogue scale. The post-test was conducted in both experimental and control groups. Result: Till the end of the study, 76 participants were taken. On day 3 of the hand grip exercise maximum of 24 (61.5%) PIVC were patent, whereas in control group 5 (13.5%) PIVC were able to maintain their patency. On day 5 of exercise 34 (91.9%) PIVC were replaced with a cause of phlebitis 33(89.2%) in the control group in comparison with the experimental group only 22 (56.4%) lines were replaced with the same cause of phlebitis 24 (61.5%). Conclusion: Hand grip exercise is important for clients, to reduce the need for the potentially painful process of placing vascular lines and also helps to control costs by reducing the number of devices used for each client and the development of phlebitis.
Evaluation of the Use of Open Versus Closed Short Peripheral Catheters on Catheter Dwell Time
Journal of Infusion Nursing, 2019
The Art and Science of Infusion Nursing S hort peripheral catheters (SPCs) are the most common clinical devices used in patients in acute care settings for various applications, such as intravenous (IV) medication and fluid administration. 1 In 2009, about 150 million SPCs were used in the United States 2 and grew to 330 in 2013. 3 , 4 In a worldwide SPC prevalence study of hospitalized adults, the majority (> 60%) received a minimum of 1 SPC during their hospital stay. 5 While many SPCs are inserted for potential need for use, evidence-based clinical indications for SPCs include access for medication, fluid, and/or blood administration. 6 The use of SPCs is associated with complications and carries potential risks to patients, including phlebitis, pain, infiltration, hematoma, and occlusion, as well as bacteremia and sepsis. 1 One limitation in using SPCs is that often they do not remain in place within the vein or lose function, requiring replacement during hospitalization. Studies indicate that the failure rate of SPCs is between 35% and 50% of cases, 1 including dislodgment, infiltration, and so forth. SPC failure subjects the patient to more venipunctures and further risk for infection, pain, potential overuse, or destruction of veins and may influence the patient experience. Manufacturers are searching for ways to reduce some of these complications and maximize SPC function with enhanced development. Over time, technological advancements of SPC structures and components have improved catheter safety and function. Some SPC design enhancements include improving materials to be more suitable for venous dwell within the vein, ergonomic enhancements for ease of use, mechanisms to avoid needle-related injuries or blood exposure during insertion, and various securement devices, extension sets, stopcocks, and hubs. 4 Equipment needed to insert and maintain SPCs varies and may consist of separate components, which must be attached before or after insertion. Manipulation of these components during insertion and tubing changes can result in several problems. Breaches in the aseptic technique during manipulation of components can potentially ABSTRACT Short peripheral catheters (SPCs) vary by design and materials. The investigators conducted a before-and-after study comparing catheter dwell time and complications with open and closed system SPCs. Many SPCs in the study were saline locks. Results showed that the closed system SPCs had a significantly longer dwell time than open system SPCs. Complications overall were few and not different between groups. Nurse survey ratings were more positive for reduced blood spillage and materials with the closed system SPC but favored the open system SPC for ease of use when handling the catheter and venipuncture. The most common reason for discontinuing the catheter was for patient discharge.
How much is catheter flow influenced by the use of closed luer lock access devices?
Nephrology Dialysis Transplantation, 2007
Background. To reduce infection risks in patients on hemodialysis with a long term central venous catheter, different types of closed luer lock access devices are used on the arterial and venous catheter hub. Although those connectors create a mechanically and microbiologically closed system in between two dialysis sessions, no data are available on the resistance those connectors exert on the blood flow during dialysis. Therefore, in the present study, flow resistance was determined in three different connectors. Methods. In an in vitro setup, different connectors were attached in between a male (Bellco BL 307 dialysis tubing) and female luer: BD Q-Syte TM (Becton-Dickinson, Utah, USA), second edition Tego TM (ICU Medical, CA, USA), and Swan-LockÛ connector (Codan, Lensahn, Germany). For a wide range of water flow rates, pressure-flow relationships were measured, simulating catheter inflow as well as catheter outflow, by reversing the flow direction. Resistances were compared to a simple male-female connection, as in a standard bloodline-catheter connection, and mathematical corrections were performed for the use of water instead of blood. Results. For a blood flow of 500mL/min, simulating clinical dialysis, the additional pressure drop is 118mmHg (Becton Dickinson), 52mmHg (Codan), and 23mmHg (Tego TM) in the case of catheter inflow, while it is 74mmHg (Becton Dickinson), 40mmHg (Codan), and 27mmHg (Tego TM) in the case of catheter outflow. Resistances are also depending on the type of tubing as used during dialysis. Conclusions. In conclusion, the Tego TM and Codan connector show promising results for the use on a catheter hub during and in between dialysis sessions. Whether those resistances are in the safe range without the incidence of blood hemolysis will soon be investigated in an in vivo study.
Medical Devices: Evidence and Research, 2012
The use of totally implantable venous access devices developed as a medical device allowing mid-and long-term, frequent, repeated, or continuous injection of therapeutic products, by vascular, cavitary, or perineural access. The effective flushing of these devices is a central element to assure long-lasting use. Our experimental work demonstrates that directing the Huber point needle opening in the diametrically opposite direction of the implantable port exit channel increases the flushing efficiency. These results are consolidated by numerical computations, which support recommendations not only for their maintenance, but also for their use.
Impact of short-term hemodialysis catheters on the central veins: a catheter venographic study
European Journal of Radiology, 2004
Objective: To determine the incidence of pericatheter sleeve formation, thrombus formation, and stenosis of the central veins in hemodialysis patients with temporary catheters. Methods and material: In this prospective study, 57 patients (40 males, 17 females) with temporary dialysis catheters had catheter venography by pulling back the catheter just before removal. Patient's age range was 25-87 years (mean age, 51 years). The venographic studies were evaluated for pericatheter sleeve formation, thrombus formation, and stenosis of the brachiocephalic vein (BCV) and the superior vena cava (SVC). The IJV could only be evaluated if there was adequate filling during contrast administration. In a subgroup of patients who had had only right IJV or only right SCV catheters, impact of these catheters on the central veins was compared. Results: The catheter location was right internal jugular vein (IJV) in 26 cases, right subclavian vein (SCV) in 27 cases, left IJV in 1 case, and left SCV in 3 cases. Thirty-two patients (56%) had had only one temporary catheter and the rest had had more than one inserted. The mean dwell time for the catheters was 21 days (range 7-59 days). A pericatheter sleeve was detected on venography in 32 (56%) patients and thrombus formation was noted in 16 patients (28%). A total of 41 patients (72%) exhibited pericatheter sleeve and/or thrombus formation. While 19 of the 32 patients (59%) without previous catheterization had a sleeve around the catheter, only 13 (52%) of 25 patients who had had multiple catheters inserted had a sleeve (P > 0.05). Of the eight patients (14%) with BCV stenosis, two had >50% stenosis. Only one patient (2%) had mild stenosis of the SVC. Three patients out of 15 (20%) who had diagnostic venography for the IJV had severe stenosis of the vein.