Abstract
Central venous catheters are widely used in haemodialysis therapy, having to respect design requirements for appropriate performance. These are placed within the right atrium (RA); however, there is no prior computational study assessing different catheter designs while mimicking their native environment. Here, a computational fluid dynamics model of the RA, based on realistic geometry and transient physiological boundary conditions, was developed and validated. Symmetric, split and step catheter designs were virtually placed in the RA and their performance was evaluated by: assessing their interaction with the RA haemodynamic environment through prediction of flow vorticity and wall shear stress (WSS) magnitudes (1); and quantifying recirculation and tip shear stress (2). Haemodynamic predictions from our RA model showed good agreement with the literature. Catheter placement in the RA increased average vorticity, which could indicate alterations of normal blood flow, and altered WSS magnitudes and distribution, which could indicate changes in tissue mechanical properties. All designs had recirculation and elevated shear stress values, which can induce platelet activation and subsequently thrombosis. The symmetric design, however, had the lowest associated values (best performance), while step design catheters working in reverse mode were associated with worsened performance. Different tip placements also impacted on catheter performance. Our findings suggest that using a realistically anatomical RA model to study catheter performance and interaction with the haemodynamic environment is crucial, and that care needs to be given to correct tip placement within the RA for improved recirculation percentages and diminished shear stress values.
Highlights
Haemodialysis is used clinically during kidney failure to support blood filtering. This process is enabled by the use of dialysis catheters, devices with a tip placed within the proximal third of the superior vena cava (SVC), the right atrium (RA), or the inferior vena cava (IVC) [1]
Right atrial computational fluid dynamics (CFD) results were compared against in vivo and in vitro results from the literature; this comparison focused on data for a healthy RA model without the presence of a catheter
In this study we present a model which provides realistic predictions of haemodynamics in the right atrium, subsequently aiding assessment of haemodialysis catheter performance
Summary
Haemodialysis is used clinically during kidney failure to support blood filtering. This process is enabled by the use of dialysis catheters, devices with a tip placed within the proximal third of the superior vena cava (SVC), the right atrium (RA), or the inferior vena cava (IVC) [1]. Computational fluid dynamics of the right atrium and evaluation of dialysis catheters conception of the study but were not involved in the data collection or analysis nor drafting of the manuscript and decision to publish
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