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Gavin NC, Wignall E, Marsh N, Marquart L, Dobeli KL, O'Brien C, Verderosa AD, Totsika M, Keogh S. Perforated intravenous catheter design is acceptable for the administration of contrast-enhanced computed tomography administration in cancer patients: Results of a pilot randomised controlled trial. J Vasc Access 2024; 25:1519-1527. [PMID: 37264630 DOI: 10.1177/11297298231171422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Optimising first time success of peripheral intravenous catheter (PIVC) insertion and reducing intravenous (IV) complications in cancer patients undergoing contrast-enhanced computed tomography (CT) is vital to ensure vascular access preservation and diagnostic accuracy. The aim of this study was to test the feasibility of a randomised controlled trial (RCT) evaluating a novel perforated PIVC compared to a standard PIVC. METHODS A single centre, parallel-group, pilot RCT was conducted between March and May 2020. Adult participants diagnosed with cancer were randomised to a non-perforated PIVC (standard care) or a PIVC with a novel perforated design (intervention) for the administration of IV contrast. There were two primary outcomes: (1) feasibility of an adequately powered RCT with pre-established criteria; and (2) all-cause PIVC failure. Secondary outcomes included: first insertion success, modes of PIVC failure, dwell time, contrast injection parameters (volume and injection rate), contrast enhancement, radiographer satisfaction and adverse events. RESULTS Feasibility outcomes were met, except for eligibility (⩾90%) and recruitment (⩾90%). In total, 166 participants were screened, 128 (77%) were eligible and of these 101/128 (79%) were randomised; 50 to standard care and 51 to intervention. First time insertion rate was 94% (47/50) in standard care and 90% (46/50) in intervention. The median dwell time was 37 minutes (interquartile range (IQR): 25-55) in standard care and 35 minutes (IQR: 25-60) in the intervention group. There was one PIVC failure, a contrast media extravasation, in the intervention group (1/51; 2%). The desired contrast injection rate was not achieved in 4/101 (4%) of participants; two from each group. Radiographers were satisfied with the contrast flow rate. CONCLUSIONS This pilot RCT suggests perforated PIVCs provide expected flow rate, with no evidence of differences in contrast enhancement to non-perforated PIVCs. The feasibility of conducting a larger powered RCT was demonstrated.
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Affiliation(s)
- Nicole C Gavin
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, QLD, Australia
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Sciences, Griffith University, Nathan, QLD, Australia
| | - Elizabeth Wignall
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Nicole Marsh
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, QLD, Australia
- Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Sciences, Griffith University, Nathan, QLD, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Louise Marquart
- School of Public Health, University of Queensland, Herston, QLD, Australia
- Queensland Institute of Medical Research Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Karen L Dobeli
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Catherine O'Brien
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Anthony D Verderosa
- School of Biomedical Sciences and Centre for Immunology and Infection Control, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Makrina Totsika
- School of Biomedical Sciences and Centre for Immunology and Infection Control, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Samantha Keogh
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, QLD, Australia
- Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Sciences, Griffith University, Nathan, QLD, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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2
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Agno KC, Yang K, Byun SH, Oh S, Lee S, Kim H, Kim K, Cho S, Jeong WI, Jeong JW. A temperature-responsive intravenous needle that irreversibly softens on insertion. Nat Biomed Eng 2024; 8:963-976. [PMID: 37903901 DOI: 10.1038/s41551-023-01116-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/26/2023] [Indexed: 11/01/2023]
Abstract
The high stiffness of intravenous needles can cause tissue injury and increase the risk of transmission of blood-borne pathogens through accidental needlesticks. Here we describe the development and performance of an intravenous needle whose stiffness and shape depend on body temperature. The needle is sufficiently stiff for insertion into soft tissue yet becomes irreversibly flexible after insertion, adapting to the shape of the blood vessel and reducing the risk of needlestick injury on removal, as we show in vein phantoms and ex vivo porcine tissue. In mice, the needles had similar fluid-delivery performance and caused substantially less inflammation than commercial devices for intravenous access of similar size. We also show that an intravenous needle integrated with a thin-film temperature sensor can monitor core body temperature in mice and detect fluid leakage in porcine tissue ex vivo. Temperature-responsive intravenous needles may improve patient care.
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Affiliation(s)
- Karen-Christian Agno
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Keungmo Yang
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang-Hyuk Byun
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Subin Oh
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Simok Lee
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Heesoo Kim
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Kyurae Kim
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Sungwoo Cho
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Won-Il Jeong
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea.
| | - Jae-Woong Jeong
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea.
- KAIST Institute for Health Science and Technology, Daejeon, Republic of Korea.
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3
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Faisal S, Barbour M, Seibel EJ, Aliseda A. Hemodynamics of Saline Flushing in Endoscopic Imaging of Partially Occluded Coronary Arteries. Cardiovasc Eng Technol 2024; 15:211-223. [PMID: 38191806 DOI: 10.1007/s13239-023-00708-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 12/19/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE Intravascular endoscopy can aid in the diagnosis of coronary atherosclerosis by providing direct color images of coronary plaques. The procedure requires a blood-free optical path between the catheter and plaque, and achieving clearance safely remains an engineering challenge. In this study, we investigate the hemodynamics of saline flushing in partially occluded coronary arteries to advance the development of intravascular forward-imaging catheters that do not require balloon occlusion. METHODS In-vitro experiments and CFD simulations are used to quantify the influence of plaque size, catheter stand-off distance, saline injection flowrate, and injection orientation on the time required to achieve blood clearance. RESULTS Experiments and simulation of saline injection from a dual-lumen catheter demonstrated that flushing times increase both as injection flow rate (Reynolds number) decreases and as the catheter moves distally away from the plaque. CFD simulations demonstrated that successful flushing was achieved regardless of lumen axial orientation in a 95% occluded artery. Flushing time was also found to increase as plaque size decreases for a set injection flowrate, and a lower limit for injection flowrate was found to exist for each plaques size, below which clearance was not achieved. For the three occlusion sizes investigated (90, 95, 97% by area), successful occlusion was achieved in less than 1.2 s. Investigation of the pressure fields developed during injection, highlight that rapid clearance can be achieved while keeping the arterial overpressure to < 1 mmHg. CONCLUSIONS A dual lumen saline injection catheter was shown to produce clearance safely and effectively in models of partially occluded coronary arteries. Clearance was achieved across a range of engineering and clinical parameters without the use of a balloon occlusion, providing development guideposts for a fluid injection system in forward-imaging coronary endoscopes.
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Affiliation(s)
- Syed Faisal
- Mechanical Engineering Department, University of Washington, Seattle, WA, USA
| | - Michael Barbour
- Mechanical Engineering Department, University of Washington, Seattle, WA, USA.
| | - Eric J Seibel
- Mechanical Engineering Department, University of Washington, Seattle, WA, USA
| | - Alberto Aliseda
- Mechanical Engineering Department, University of Washington, Seattle, WA, USA
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4
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Hirata I, Mazzotta A, Makvandi P, Cesini I, Brioschi C, Ferraris A, Mattoli V. Sensing Technologies for Extravasation Detection: A Review. ACS Sens 2023; 8:1017-1032. [PMID: 36912628 PMCID: PMC10043935 DOI: 10.1021/acssensors.2c02602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/27/2023] [Indexed: 03/14/2023]
Abstract
Peripheral intravenous catheters are administered for various purposes, such as blood sampling or the infusion of contrast agents and drugs. Extravasation happens when the catheter is unintentionally directed outside of the vein due to movement of the intravascular catheter, enhanced vascular permeability, or occlusion of the upstream vein. In this article, extravasation and its mechanism are discussed. Subsequently, the sensorized devices (e.g., single sensor and multimodal detection) to identify the extravasation phenomena are highlighted. In this review article, we have shed light on both physiological and engineering points of view of extravasation and its detection approaches. This review provides an overview on the most recent and relevant technologies that can help in the early detection of extravasation.
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Affiliation(s)
- Ikue Hirata
- Center for
Materials Interfaces, Istituto Italiano
di Tecnologia, 56025 Pontedera, Pisa, Italy
| | - Arianna Mazzotta
- Center for
Materials Interfaces, Istituto Italiano
di Tecnologia, 56025 Pontedera, Pisa, Italy
- The
Biorobotics Institute, Scuola Superiore
Sant’Anna, Pontedera 56025, Italy
| | - Pooyan Makvandi
- Center for
Materials Interfaces, Istituto Italiano
di Tecnologia, 56025 Pontedera, Pisa, Italy
| | - Ilaria Cesini
- Center for
Materials Interfaces, Istituto Italiano
di Tecnologia, 56025 Pontedera, Pisa, Italy
| | - Chiara Brioschi
- IIT-Bracco
Joint Lab, Istituto Italiano di Tecnologia, 16163 Genova, Italy
- Bracco
S.p.A., 20134 Milano, Italy
| | - Andrea Ferraris
- IIT-Bracco
Joint Lab, Istituto Italiano di Tecnologia, 16163 Genova, Italy
- Bracco
S.p.A., 20134 Milano, Italy
| | - Virgilio Mattoli
- Center for
Materials Interfaces, Istituto Italiano
di Tecnologia, 56025 Pontedera, Pisa, Italy
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5
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Ang A, Michaelides A, Hallworth S, Kocher HM. Intraoperative acute compartment syndrome of the upper limb secondary to extravasation. BMJ Case Rep 2022; 15:e248454. [PMID: 35580941 PMCID: PMC9114956 DOI: 10.1136/bcr-2021-248454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2022] [Indexed: 11/03/2022] Open
Abstract
A woman in her 50s was undergoing a repeat liver resection surgery for recurrence of liver metastasis when the intravenous fluid flow was noted to be sluggish on multiple occasions. On the third examination of the right hand where the intravenous cannula was located, surgery was halted as there was extensive swelling from the hand to the biceps and the hand had started turning blue. A diagnosis of acute upper limb compartment syndrome secondary to extravasation exacerbated by metaraminol was made by the anaesthetist and surgeon. Fasciotomies of the right upper limb were performed, and perfusion was restored. A hand surgeon arrived shortly after and completed decompressing the upper limb compartments.A literature review revealed risk factors such as communication barriers, age and chemotherapy were present in this case. Enhanced monitoring is needed in the context of unsatisfactory infusion flow rates perioperatively.
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Affiliation(s)
- Andrew Ang
- Barts and the London HPB Centre, Barts Health NHS Trust, London, London, UK
| | - Athena Michaelides
- Barts and the London HPB Centre, Barts Health NHS Trust, London, London, UK
| | - Stephen Hallworth
- Department of Anaesthetics, Barts Health NHS Trust, London, London, UK
| | - Hemant M Kocher
- Barts and the London HPB Centre, Barts Health NHS Trust, London, London, UK
- Barts Cancer Institute, Queen Mary University of London, London, London, UK
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6
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Faisal S, Seibel EJ, Aliseda A. Optimization Study of the Hemodynamics of Saline Flushing in Endoscopic Imaging of Chronic Total Occlusions (CTOs). Cardiovasc Eng Technol 2021; 12:541-555. [PMID: 34131832 DOI: 10.1007/s13239-021-00550-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE In this study, in vitro experiments and computational fluid dynamic (CFD) simulations are used to expand the understand of the physics of saline flushing of a blocked artery to enable optical imaging. This process involves saline injection, mixing with blood, and advection of the mixture away from the region of interest to provide a clear optical path for imaging. METHODS CFD simulations are used as a rapid turn-around tool for the evolutionary design process of an endovascular catheter that combines imaging forward-viewing element with saline flushing lumens. RESULTS A novel design and control technique is developed that provides the method to regulate the pressure in a blocked artery during saline flushing, so only small deviations from physiological pressure values are exerted on the damaged artery wall at any time, minimizing risk of rupture. In vitro experiments demonstrate the optical clearing process in phantoms simulating chronic total occlusions (CTOs) in coronary arteries with an opaque blood surrogate being removed by saline flushing. With the CFD compared by the experiments, parametric analyses of artery diameter and curvature, and flushing lumen diameter size were conducted to understand their impact on flushing times and pressures. Different plaque morphologies were studied to explore the feasibility of saline flushing in different CTO conditions. CONCLUSIONS A new catheter design is demonstrated to safely and effectively produce saline flushing, leading to a clear optical imaging field, and an improved technique is outlined that overcomes some practical challenges and limitations commonly encountered in angioscopy.
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Affiliation(s)
- Syed Faisal
- Mechanical Engineering Department, University of Washington, Seattle, USA
| | - Eric J Seibel
- Mechanical Engineering Department, University of Washington, Seattle, USA
| | - Alberto Aliseda
- Mechanical Engineering Department, University of Washington, Seattle, USA.
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7
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Tawfik A, Hozack B, Melendez J, Varghese B, Katt BM, Beredjiklian P, Nakashian M. Impending Upper Arm Compartment Syndrome Secondary to Intravenous Fluid Infiltration. Cureus 2021; 13:e15671. [PMID: 34277262 PMCID: PMC8282358 DOI: 10.7759/cureus.15671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/27/2022] Open
Abstract
We report the case of an 81-year-old female who developed an upper arm anterior compartment syndrome from the mass effect caused by an infiltrated intravenous access catheter. The patient’s anterior compartment became tense and uncompressible, and the patient developed radial nerve palsy. A fasciotomy was performed, resulting in the evacuation of 100 mL of fluid. Over the course of the patient’s follow-up, motor and sensory function slowly returned. In atraumatic patients with intravenous access, the development of a tense compartment with developing nerve palsies should warrant workup for possible compartment syndrome due to mass effect. If treated promptly with fasciotomy, the complications of this limb-threatening condition can be minimized or possibly reversed.
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Affiliation(s)
- Amr Tawfik
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA.,Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, New Brunswick, USA
| | - Bryan Hozack
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Justin Melendez
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, New Brunswick, USA
| | - Bobby Varghese
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, New Brunswick, USA
| | - Brian M Katt
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, New Brunswick, USA
| | - Pedro Beredjiklian
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
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8
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Armendariz T, West J, Olson DM, Stutzman SE, De Simone N. Is a 20 gauge fenestrated intravenous catheter non-inferior to a 18 gauge standard catheter for apheresis procedures? A pilot study. J Clin Apher 2021; 36:606-611. [PMID: 33843086 DOI: 10.1002/jca.21900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Peripheral venous access has been promoted as the safest, quickest, and most easily achievable route for performing apheresis procedures by the American Society for Apheresis' Choosing Wisely campaign. The current literature regarding catheter size and selection for both draw and return access is limited. Furthermore, the Infusion Nurses Society recommends using the smallest gauge catheter possible for the prescribed therapy in order to limit vein trauma and phlebitis. Since there is a lack of evidence to guide selection of catheter size for return access during therapeutic apheresis procedures (TAPs) for patients with chronic conditions, this pilot study seeks to compare the performance of a 20-gauge fenestrated (20G) catheter to a standard 18-gauge (18G) intravenous catheter. METHODS This non-inferiority pilot study randomized 26 subjects during 74 TAPs to either 20G fenestrated catheter or 18G standard catheter. RESULTS There were no statistically significant differences for variables associated with the efficiency of the TAPs comparing 20G to 18G catheter for inlet rate (P = .8666), return pressure (P = .9427), blood processed (P = .4318), or total procedure time (P = .3184). CONCLUSION The results from this pilot study suggest that 20G fenestrated catheter is non-inferior to 18G standard catheters. Additional studies with increased power are warranted to confirm these findings.
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Affiliation(s)
- Tomas Armendariz
- Apheresis Clinic, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - James West
- Apheresis Clinic, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - DaiWai M Olson
- Apheresis Clinic, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sonja E Stutzman
- Apheresis Clinic, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nicole De Simone
- Apheresis Clinic, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Novel Design of Peripheral Infusion Catheter Improves the Kinetics of Intravenous Drug Release. J Cardiovasc Transl Res 2021; 14:883-893. [PMID: 33415522 DOI: 10.1007/s12265-020-10096-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
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.
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10
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More holes, more contrast? Comparing an 18-gauge non-fenestrated catheter with a 22-gauge fenestrated catheter for cardiac CT. PLoS One 2020; 15:e0234311. [PMID: 32511272 PMCID: PMC7279574 DOI: 10.1371/journal.pone.0234311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 05/23/2020] [Indexed: 11/19/2022] Open
Abstract
Objective To compare the performance of an 18-gauge nonfenestrated catheter (18-NFC) with a 22-gauge fenestrated catheter (22-FC) for cardiac CT angiography (CCTA) in patients with suspected coronary heart disease. Subjects and methods 74 consecutive patients imaged on a 2nd generation dual-source CT with arterial phase CCTA were included in this retrospective investigation to either an 18-NFC or 22-FC. In comparison to the 18-NFC, the 22-FC has three additional perforations for contrast agent dispersal proximal to the tip. We examined the two groups for differences in their average attenuation in the right and left ventricles (RV, LV) and in the atrium (RA, LA) as well as in the proximal right coronary artery (RCA) and the left main coronary artery (LM). The averages were calculated for both the 18-NFC and 22-FC. Results Catheters were successfully placed on the first attempt 97% (36/37) for 18-NFC and 95% (35/37) for the 22-FC. The following enhancement levels were measured: 22-FC (in Hounsfield-Units (HU)): RV = 203±29, LV = 523±36, RA = 198±29, LA = 519±38, RCA = 547±26, LM = 562±25; 18-NFC: RV = 146±26, LV = 464±32, RA = 141±24, LA = 438±35, RCA = 501±23, LM = 523±23; RV (p = 0,03), LV (p = 0.12), RA (p = 0.02), LA (p = 0.04), RCA (p = 0.3), LM (p = 0.33). Conclusion No significant differences in attenuation levels as well as in image quality of the coronary arteries were found between NFC and FC. Nevertheless, the 22-gauge FC examinations showed significantly higher attenuation in the left and right atrium as well as the right ventricle. Patients with poor venous access may benefit from a smaller gauge catheter that can deliver sufficiently high flow rates for CCTA.
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11
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Kim H, Park C. Acute compartment syndrome due to extravasation of peripheral intravenous blood transfusion. Saudi J Anaesth 2020; 14:221-223. [PMID: 32317879 PMCID: PMC7164454 DOI: 10.4103/sja.sja_565_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/20/2019] [Indexed: 11/04/2022] Open
Abstract
Extravasation is an inadvertent injection or leakage of fluid and drugs in the extravascular or subcutaneous space. The extravasation by massive transfused blood results in the elevation of intra-compartmental pressures. Severely increased pressure may lead to acute compartment syndrome (ACS). A 50-year-old man underwent craniectomy for traumatic subdural hemorrhage of the brain. During intraoperative periods, the blood components were transfused by rapid transfusion device and manual pressurized pumping through the central and peripheral lines because of hemorrhagic hypovolemic shock. Approximately 30 minutes after transfusion, we found a hardened right low leg that was obscured by the surgical drape. Immediately, fasciotomy was performed to release all four compartments. The early recognition and treatment of ACS were important factors contributing to anatomical structure salvage and preservation of function. Anesthesia providers should check the site of the insertion of the intravenous catheter, especially while pressurized massive transfusion via the peripheral intravenous catheter.
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12
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The Usefulness of Fenestrated Intravenous Catheters Compared With Nonfenestrated Catheter for Cardiac Multidetector Computed Tomography. J Comput Assist Tomogr 2019; 43:423-427. [PMID: 31082947 DOI: 10.1097/rct.0000000000000855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To compare the fenestrated intravenous (IV) catheter and nonfenestrated conventional IV catheter in terms of contrast enhancement and injection pressure for coronary computed tomography angiography. METHODS Three hundred patients were prospectively and consecutively enrolled to either the 20-gauge nonfenestrated conventional (group 1) IV catheter group or the 20-gauge fenestrated (group 2) or 22-gauge fenestrated (group 3) IV catheter groups. We analyzed mean vascular attenuations in the ascending aorta, left main coronary artery, left ventricular (LV) cavity, and descending aorta. Injection pressure using pound-force per square inch (PSI) and extravasation of contrast media were recorded. RESULTS Mean attenuations of the left main coronary artery, LV cavity, and descending aorta were significantly higher in group 2 than in group 1 (P ≤ 0.001, P ≤ 0.001, P ≤ 0.001, respectively). Moreover, injection pressure was significantly lower in group 2 than in group 1 (208.3 vs 216.9 PSI, P = 0.006). Mean vascular attenuations of the left main coronary artery, LV cavity, and descending aorta were significantly higher in group 3 than in group 1 (P = 0.016, P = 0.029, P = 0.001, respectively). However, injection pressure was not statistically significant between group 3 and group 1 (213.6 vs 216.9 PSI, P = 0.355). No extravasation occurred in any patient groups during the study. CONCLUSIONS We suggest that fenestrated IV catheter is useful in terms of higher vascular attenuation and lower injection pressure for coronary computed tomography angiography. It has a potential merit in patients with fragile and small veins.
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13
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Standard Short Peripheral Catheters (SPCs) Versus Power Injectable SPCs During Contrast Computed Tomography and Magnetic Resonance Imaging Angiography: A Quality Improvement Study. JOURNAL OF INFUSION NURSING 2018; 41:358-364. [PMID: 30399071 DOI: 10.1097/nan.0000000000000301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To perform high-resolution computed tomography and magnetic resonance imaging angiographies, contrast typically is rapidly injected through a 20-gauge or larger short peripheral catheter (SPC). Intravenous access in infants and children can be challenging, and the use of large-gauge catheters is not always feasible. An institutional review board-approved quality improvement study was undertaken at a 250-bed pediatric hospital on Florida's Gulf Coast that compared the use and outcomes of standard SPCs (nonfenestrated) versus a power injectable SPC (fenestrated with 3 side holes distal to the catheter tip).
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14
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Fulker D, Sayed Z, Simmons A, Barber T. Computational Fluid Dynamic Analysis of the Hemodialysis Plastic Cannula. Artif Organs 2017; 41:1035-1042. [DOI: 10.1111/aor.12901] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 10/13/2016] [Accepted: 10/19/2016] [Indexed: 12/26/2022]
Affiliation(s)
- David Fulker
- School of Mechanical and Manufacturing Engineering; University of New South Wales; Sydney Australia
| | - Zakir Sayed
- School of Mechanical and Manufacturing Engineering; University of New South Wales; Sydney Australia
| | - Anne Simmons
- School of Mechanical and Manufacturing Engineering; University of New South Wales; Sydney Australia
| | - Tracie Barber
- School of Mechanical and Manufacturing Engineering; University of New South Wales; Sydney Australia
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Tamura A, Kato K, Kamata M, Suzuki T, Suzuki M, Nakayama M, Tomabechi M, Nakasato T, Ehara S. Selection of peripheral intravenous catheters with 24-gauge side-holes versus those with 22-gauge end-hole for MDCT: A prospective randomized study. Eur J Radiol 2016; 87:8-12. [PMID: 28065379 DOI: 10.1016/j.ejrad.2016.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/04/2016] [Accepted: 12/03/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To compare the 24-gauge side-holes catheter and conventional 22-gauge end-hole catheter in terms of safety, injection pressure, and contrast enhancement on multi-detector computed tomography (MDCT). MATERIALS & METHODS In a randomized single-center study, 180 patients were randomized to either the 24-gauge side-holes catheter or the 22-gauge end-hole catheter groups. The primary endpoint was safety during intravenous administration of contrast material for MDCT, using a non-inferiority analysis (lower limit 95% CI greater than -10% non-inferiority margin for the group difference). The secondary endpoints were injection pressure and contrast enhancement. RESULTS A total of 174 patients were analyzed for safety during intravenous contrast material administration for MDCT. The overall extravasation rate was 1.1% (2/174 patients); 1 (1.2%) minor episode occurred in the 24-gauge side-holes catheter group and 1 (1.1%) in the 22-gauge end-hole catheter group (difference: 0.1%, 95% CI: -3.17% to 3.28%, non-inferiority P=1). The mean maximum pressure was higher with the 24-gauge side-holes catheter than with the 22-gauge end-hole catheter (8.16±0.95kg/cm2 vs. 4.79±0.63kg/cm2, P<0.001). The mean contrast enhancement of the abdominal aorta, celiac artery, superior mesenteric artery, and pancreatic parenchyma in the two groups were not significantly different. CONCLUSION In conclusion, our study showed that the 24-gauge side-holes catheter is safe and suitable for delivering iodine with a concentration of 300mg/mL at a flow-rate of 3mL/s, and it may contribute to the care of some patients, such as patients who have fragile and small veins. (Trial registration: UMIN000023727).
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Affiliation(s)
- Akio Tamura
- Department of Radiology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka 020-8505, Japan.
| | - Kenichi Kato
- Department of Radiology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka 020-8505, Japan.
| | - Masayoshi Kamata
- Iwate Medical University Hospital, 19-1 Uchimaru, Morioka 020-8505, Japan.
| | - Tomohiro Suzuki
- Department of Radiology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka 020-8505, Japan.
| | - Michiko Suzuki
- Department of Radiology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka 020-8505, Japan.
| | - Manabu Nakayama
- Department of Radiology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka 020-8505, Japan.
| | - Makiko Tomabechi
- Department of Radiology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka 020-8505, Japan.
| | - Tatsuhiko Nakasato
- Department of Radiology, Southern Tohoku Research Institute for Neuroscience, 7-115 Yatsuyamada, Koriyama 963-8563, Japan.
| | - Shigeru Ehara
- Department of Radiology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka 020-8505, Japan.
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Fulker D, Simmons A, Kabir K, Kark L, Barber T. The Hemodynamic Effects of Hemodialysis Needle Rotation and Orientation in an Idealized Computational Model. Artif Organs 2015; 40:185-9. [DOI: 10.1111/aor.12521] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- David Fulker
- School of Mechanical and Manufacturing Engineering; University of New South Wales; Sydney New South Wales Australia
| | - Anne Simmons
- School of Mechanical and Manufacturing Engineering; University of New South Wales; Sydney New South Wales Australia
| | - Kaveh Kabir
- School of Mechanical and Manufacturing Engineering; University of New South Wales; Sydney New South Wales Australia
| | - Lauren Kark
- Graduate School of Biomedical Engineering; University of New South Wales; Sydney New South Wales Australia
| | - Tracie Barber
- School of Mechanical and Manufacturing Engineering; University of New South Wales; Sydney New South Wales Australia
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Ghata N, Aldredge RC, Bec J, Marcu L. Computational analysis of the effectiveness of blood flushing with saline injection from an intravascular diagnostic catheter. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2014; 30:1278-1293. [PMID: 24953876 PMCID: PMC4429308 DOI: 10.1002/cnm.2657] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 01/17/2014] [Accepted: 06/14/2014] [Indexed: 06/03/2023]
Abstract
Optical techniques including fluorescence lifetime spectroscopy have demonstrated potential as a tool for study and diagnosis of arterial vessel pathologies. However, their application in the intravascular diagnostic procedures has been hampered by the presence of blood hemoglobin that affects the light delivery to and the collection from the vessel wall. We report a computational fluid dynamics model that allows for the optimization of blood flushing parameters in a manner that minimizes the amount of saline needed to clear the optical field of view and reduces any adverse effects caused by the external saline jet. A 3D turbulence (k - ω) model was employed for Eulerian-Eulerian two-phase flow to simulate the flow inside and around a side-viewing fiber-optic catheter. Current analysis demonstrates the effects of various parameters including infusion and blood flow rates, vessel diameters, and pulsatile nature of blood flow on the flow structure around the catheter tip. The results from this study can be utilized in determining the optimal flushing rate for given vessel diameter, blood flow rate, and maximum wall shear stress that the vessel wall can sustain and subsequently in optimizing the design parameters of optical-based intravascular catheters.
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Affiliation(s)
- Narugopal Ghata
- Department of Mechanical and Aerospace Engineering, University of California, Davis, CA 95616, U.S.A
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I.v. contrast administration with dual source 128-MDCT: a randomized controlled study comparing 18-gauge nonfenestrated and 20-gauge fenestrated catheters for catheter placement success, infusion rate, image quality, and complications. AJR Am J Roentgenol 2014; 202:1166-70. [PMID: 24848812 DOI: 10.2214/ajr.13.11730] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the performance of a 20-gauge fenestrated catheter with an 18-gauge nonfenestrated catheter for i.v. contrast infusion during MDCT. SUBJECTS AND METHODS Two hundred five adult outpatients imaged on a dual-source 128-MDCT scanner with arterial phase body CT (flow rates, 5.0-7.5 mL/s) were randomized to either an 18-gauge nonfenestrated or 20-gauge fenestrated catheter. After randomization, any 18-gauge nonfenestrated subjects whose veins were deemed insufficient for that catheter gauge were assigned to a third cohort for placement of a 20-gauge fenestrated catheter. Catheter placement success, infusion rate, contrast volume, maximum pressure, complications, and aortic enhancement levels were recorded. RESULTS Catheters were placed on the first attempt in 97% (100/103) for 18-gauge nonfenestrated and 94% (96/102) for 20-gauge fenestrated placements and in two or fewer attempts in 99% of both groups. Mean infusion rates (5.74 mL/s for 18-gauge nonfenestrated and 5.58 mL/s for 20-gauge fenestrated placements) and aortic enhancement levels were not significantly different. Maximum pressure was higher with 20-gauge fenestrated catheters (mean ± SD, 230.5 ± 27.6 pounds per square inch [psi]) than 18-gauge nonfenestrated catheters (mean ± SD 215.6 ± 32.8 psi) (p = 0.002). One subject with an 18-gauge nonfenestrated catheter had a high-pressure alarm. In the third cohort, a 20-gauge fenestrated catheter was successfully placed in two or fewer attempts in 85% (28/33), with one minor extravasation attributed to vein insufficiency. CONCLUSION A 20-gauge fenestrated catheter performs similarly to an 18-gauge nonfenestrated catheter with respect to i.v. contrast infusion rates and aortic enhancement levels and can be placed in most subjects whose veins are deemed insufficient for an 18-gauge catheter.
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Kadom N, Hashim HD, Olsen C, Cefaratti M, Bulas D, Shalaby-Rana E. Nursing role model for computed tomography contrast injection decreases extravasation rates. J Pediatr Nurs 2012; 27:113-8. [PMID: 22341189 DOI: 10.1016/j.pedn.2010.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 10/07/2010] [Accepted: 10/17/2010] [Indexed: 10/18/2022]
Abstract
Extravasation of intravenous contrast administered for computed tomography remains of concern in pediatric patients. It is of great interest to any pediatric radiology department to decrease extravasation events in an effort to reduce even small adverse outcomes and improve the overall patient experience in the radiology department. Here, a total of 17 extravasation events, as reported and documented in departmental quality assurance at our institution over 4 years, were retrospectively reviewed for factors contributing to the number of adverse extravasation events. We found that pediatric nursing plays a central role in both achieving and maintaining a low extravasation rate at our institution.
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Affiliation(s)
- Nadja Kadom
- Children's National Medical Center, Washington, DC, USA.
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