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

Abstract

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.

From insertion to removal: A multicenter survival analysis of an admitted cohort with peripheral intravenous catheters inserted in the emergency department

“…21 Although it was beyond the scope of this study, this finding does suggest that PIF is associated with other mechanistic causes and is certainly worthy of further investigation. 22 The PIVCs inserted by medical students appear to be a clinician factor associated with PIF. This finding may be relevant to this group's first clinical exposure to PIVC.…”

Incidence, severity and risk factors of peripheral intravenous cannula‐induced complications: An observational prospective study

“…The results of several studies have indicated a multiple aetiology of phlebitis, as primarily being a physicochemical phenomenon (Maki & Ringer, ; Mestre Roca et al, ). By using computational fluid dynamics (CFD) to report the hemodynamic measure within the vein and catether, Piper et al () established that increasing the infusion flow rate and positioning the catheter tip along the vein wall creates turbulence, that is, stasis that causes vein wall shear stress and phlebitis.…”

Peripheral intravenous catheter difficulty – A clinical survey of registered nurse and critical care nurse performance

“…These patients often have limited vascular access. Repeated unsuccessful PIVC attempts cause pain and discomfort for patients (Menegolo et al., ) and are also associated with increased healthcare costs (Tuffaha et al., ) and increased risk of failure (Piper et al., ; Wallis et al., ).…”