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. 2022 Sep;17(9):1382-1384.
doi: 10.2215/CJN.01470222. Epub 2022 Jul 11.

Central Venous Catheter Malfunction in Children: A Bioengineering Approach

Claudia Bruno  1 , Rayan Moumneh  1 , Emilie Sauvage  2 , Lynsey Stronach  3 , Kathryn Waters  3 , Ian Simcock  3   4 , Owen Arthurs  3 , Silvia Schievano  2   3 , Claudio Capelli  2   3 , Rukshana Shroff  1   3
Affiliations

Central Venous Catheter Malfunction in Children: A Bioengineering Approach

Claudia Bruno et al. Clin J Am Soc Nephrol. 2022 Sep.
No abstract available

Keywords: bioengineering; catheter design; computational fluid dynamics; dialysis access; hemodialysis access; pediatric catheters performance; pediatric nephrology; vascular access.

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Figures

Figure 1.
Figure 1.
Reconstructed models of the catheters and results from the computational and clinical studies. (A) Three-dimensional models of the central venous catheters (CVCs) included in this study, with magnification on the details of the side holes. (a) Tesio (6.5F); (b) Hemo-Cath (8F); (c) Pediatric Split Cath (10F); and (d) Split Cath III (14F). (B) Computational fluid dynamics to study changes in hemodynamics parameters in an anatomic model of the superior vena cava (SVC) and the right atrium (RA) in the presence of a Hemo-Cath 8F CVC and under clinical working conditions. Central picture: velocity pathlines for the Hemo-Cath 8F. Blood is aspirated from the arterial lumen in the SVC, whereas the venous lumen takes blood back to the RA. Lateral pictures illustrate several results from different sections of the geometry; color maps are reported with the corresponding legend ranging from the minimum (blue) to the maximum (red) values measured. (a) Velocity contours plotted at the cross-section of the SVC, before and after CVC insertion. Blood velocity inside the vein increases in the presence of the catheter; increases range between 3% and 15% in average velocity and between 21% and 34% in Vmax. (b) Wall shear stress plotted on the SVC (front and back views are shown). Increased shear stress is recorded after catheter insertion; the Pediatric Split Cath registered a three-fold greater increase, whereas, in the remaining CVC models, differences ranged between 40% and 48%. (c) Asymmetric eddies (red arrows) are found in the SVC cross-section when the catheter is placed inside the vein. (d) A region of low velocity or blood stagnation is shown at the tip of the arterial lumen. (e) Close up of the shear stress distribution in the region close to the arterial side holes, where higher values of shear stress are measured (red arrows). (Right panel) A region of blood stagnation can also be found in the Split Cath 10F (top) together with high shear stress levels in the region close to the most proximal arterial side holes (bottom). (C) Table summarizing the most important results obtained from both the engineering simulations and the observations in clinical patients. Maximum blood velocity was measured at the smallest cross-section of the vein before and after catheter placement, while shear stress values were computed in a volume of fluid containing the arterial tip of the catheters. SS, shear stress.
See this image and copyright information in PMC

References

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