The relationship between the tip position of an indwelling venous catheter and the subcutaneous edema

Murayama, Ryoko; Takahashi, Toshiaki; Tanabe, Hidenori; Yabunaka, Koichi; Oe, Makoto; Oya, Maiko; Uchida, Miho; Komiyama, Chieko; Sanada, Hiromi

doi:10.5582/bst.2015.01114

Cited by 24 publications

(29 citation statements)

References 19 publications

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“…Recent investigation by Murayama et al . of 154 patients supports our findings, indicating a strong correlation between phlebitis and contact of the catheter tip with the vein wall . These findings explain in part the etiology and pathogenesis of mechanical SPCT and were used by our group to develop a new SPC device that would eliminate the mechanical irritation to the endothelial cells, with the aim of minimizing the progression rate of SPCT, and potentially extending the catheter dwell time in situ beyond the currently recommended 3 days.…”

Section: Introductionsupporting

confidence: 83%

Novel short peripheral catheter design for prevention of thrombophlebitis

Weiss

Yaakobovitch

Tal

et al. 2019

Journal of Thrombosis and Haemostasis

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Phlebitis is one of the most frequent complications related to short peripheral catheters (SPC). A new SPC design, aimed for minimizing mechanical phlebitis, was tested in vivo in swine. MRI analysis revealed 40% less inflammation with the new SPC design compared to commercial SPC. The results confirm that our SPC biomechanical design approach can minimize phlebitis rates. Summary BackgroundShort peripheral catheters (SPCs) are the most common intravenous device in today's medical practice. Short peripheral catheter thrombophlebitis (SPCT) occurs in up to 80% of hospitalized patients. Symptoms appear on average 3 days after catheter insertion and can lead to extended hospitalization and increased related costs. Here we introduce a novel SPC, named very short peripheral catheter (VSPC), that was designed to minimize biomechanical irritation and improve blood flow. ObjectiveThe goal was to test the performance of the novel catheter in vivo for reduction of thrombophlebitis. MethodsVery short peripheral catheter prototypes were inserted into swine ear veins (n = 12). Verification of the catheter conformation in situ and blood perfusion was performed using Echo‐Doppler. The SPCT development rate was measured using magnetic resonance imaging (MRI), 4 and 12 days after catheter insertion, and analyzed by means of edema and inflammation intensities. Blind histopathology analysis was performed on the veins postmortem. Clinically available SPC was used as a reference. ResultsOperation of the VSPC devices did not require any special skills over those used for the clinically available SPC. Echo‐Doppler imaging confirmed that in contrast to the traditional SPC, the VSPC avoided contact with the vein wall and allowed better blood perfusion. The MRI analysis revealed 2‐fold inflammation and edema rates (~80%) in the veins cannulated with the commercial SPC, whereas rates of only ~40% were seen with the novel VSPC. A similar trend was noticed in the histopathology analysis. ConclusionsThe results indicate that the novel catheter design significantly reduced SPCT rates and demonstrated proof of concept for our biomechanical approach.

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Section: Introductionsupporting

confidence: 83%

Novel short peripheral catheter design for prevention of thrombophlebitis

Weiss

Yaakobovitch

Tal

et al. 2019

Journal of Thrombosis and Haemostasis

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“…In situ failure is associated with a triad of definitions some which are not mutually exclusive; (i) infiltration, i.e. where the infusion inadvertently escapes the vein lumen and/or is infused into the subcutaneous tissues 6 ; (ii) occlusion, also referred to as blocked, where flushing or aspirating from the PIVC is not possible 7 ; and (iii) phlebitis and/or thrombophlebitis 8 leading to infection (either local or systemic), with systemic infection being particularly serious. Importantly, phlebitis is not always associated with thrombus formation, and can occur within the catheter potentially occluding due to fibrin deposition around the access port without any thrombus evident (catheter occlusion without vein occlusion), however, the two mechanisms are strongly inter-related.…”

Section: Introductionmentioning

confidence: 99%

The mechanistic causes of peripheral intravenous catheter failure based on a parametric computational study

Piper

Carr

Kelsey

et al. 2018

Sci Rep

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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.

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“…The catheter being in contact with blood vessels during placement was suggested to be a factor related to high expression of SERPINE1 (p = 0.04). Mechanical stimulation of the blood vessel wall by a catheter is a risk factor for CF that has been pointed out in our previous studies (32). It is suggested that inflammation by simulation occurs when the tip of the catheter contacts the vascular endothelial cells (33).…”

Section: Discussionmentioning

confidence: 76%

“…This result will be useful for devising and evaluating future measures to prevent CF in clinical nursing. The prevention of mechanical stimuli for the prevention of CF has been advocated in recent years (32)(33)(34). Since this study suggested that the catheter tip has an effect on the blood vessel wall and coagulation, it may be advisable that clinical nurses need to pay attention to the fixation of the catheter for confirmation.…”

Section: Discussionmentioning

confidence: 99%

Catheter tips are a possible resource for biological study on catheter failure

Takahashi

Minematsu

Murayama

et al. 2019

DD&T

Self Cite

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Few studies have investigated the molecular mechanisms of catheter failure (CF). Herein, we performed histological and molecular biological analyses of the catheter tip to demonstrate its potential as a resource for biological investigation. Additionally, we searched for risk factors for the development of inflammation and coagulation, which are pathological conditions clarified by biological analysis. The CF group included 30 failed catheters involving thrombus and subcutaneous edema identified by ultrasonography. The No-CF group included 26 catheters with no complications. The removed catheter tips were fixed for hematoxylin-eosin (HE) staining with the application of a real-time reverse transcriptase polymerase chain reaction for eukaryotic 18S ribosomal RNA (rRNA), interleukin 1β, tumor necrosis factor α, tissue plasminogen activator, and plasminogen activator inhibitor 1 (SERPINE1). HE staining identified attached nuclear cells on the inner surfaces of both CF and No-CF catheters. The 18S rRNA was amplified in all samples. The expression level of SERPINE1 was significantly higher in the CF group than in the No-CF group (p = 0.01), whereas the expression levels of other genes did not differ between the groups. Symptoms of CF associated with the expression of SERPINE1 were analyzed. The catheter being in contact with blood vessels during placement was a suggested factor related to the high expression of SERPINE1 (p = 0.04). Catheter tips are a potential resource for biological investigation, and expression analysis of the attached cells can reflect the pathological condition of the catheterized tissue. Further studies using catheter tips are required to elucidate the molecular mechanisms of CF.

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The relationship between the tip position of an indwelling venous catheter and the subcutaneous edema

Cited by 24 publications

References 19 publications

Novel short peripheral catheter design for prevention of thrombophlebitis

Novel short peripheral catheter design for prevention of thrombophlebitis

The mechanistic causes of peripheral intravenous catheter failure based on a parametric computational study

Catheter tips are a possible resource for biological study on catheter failure

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