Therapeutics and Clinical Risk Management (Sep 2024)
Optimizing Infusate Flow Patterns for Minimizing Vein Wall Trauma: An Exploratory Study with a Modified off-Axis Catheter Tip Opening
Abstract
Amit Bahl,1 S Matthew Gibson,2 Alexis Walton3 1Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA; 2Vascular Access Consulting, Henderson, KY, USA; 3Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USACorrespondence: Amit Bahl, Oakland University William Beaumont School of Medicine, 586 Pioneer Drive, Rochester, MI, 48309, USA, Email [email protected]: Modifying the PIVC tip to direct infusates toward areas of highest hemodilution may reduce vein wall damage. This study compared flow patterns between a traditional PIVC with a central opening and one with an off-axis aperture.Methods: This was an exploratory observational analysis conducted at a tertiary care emergency department (ED) comparing flow patterns of two intravenous catheters: PIVC 1 (2.95 cm 20 gauge [Autoguard, Becton Dickinson]) and PIVC 2 (3.68 cm 20 gauge [Osprey, SkyDance Vascular]). Adult ED patients with PIVCs placed via traditional palpation/visualization method and with ultrasound capturing the flushing were eligible participants. Ultrasounds were reviewed to determine vein, catheter, and flow characteristics. The primary outcome was angle of the infusate leaving the catheter. Secondary outcomes included direction of catheter tip against vein wall, distance away from vein wall, vasospasm, and laminar/turbulent flow.Results: Data from December 2023 included 28 catheters (10 PIVC 1, 18 PIVC 2). The average patient age was 53.7 years; 53.6% were female. Vein diameter/depth were similar: 0.35 cm/0.41 cm for PIVC 1 and 0.37 cm/0.47 cm for PIVC 2. The catheter tip pointed posteriorly towards the vein wall in 60% of PIVC 1 vs 11.1% in PIVC 2 (P=0.018). The angle of infusate flow away from the vein wall was 0.20° (SD 0.63) for PIVC 1 and 7.61° (SD 5.71) for PIVC 2 (P< 0.001). Flow at 0° occurred in 90% of PIVC 1 vs 16.7% in PIVC 2 (P< 0.001).Conclusion: In this exploratory investigation, a peripheral vascular access device with an off-axis tip aperture of demonstrated a sharper infusate flow angle away from the vein wall compared to a traditional central opening device. This redirection may reduce vein wall trauma and complications, though further research is needed to pair clinical outcomes with this technology.Keywords: peripheral intravenous access, hemodilution, flow pattern, infusates, modified catheter tip, catheter length
