Abstract
In this study we apply methods to determine the tendency for thrombus formation in different central venous catheters (CVC) models associated with flow rate variation. To calculate the thrombogenic potential, we proposed a new numerical model of the platelet lysis index (PLI) equation. To compare the results of PLI and flow rate in different models of catheters, numerical calculations were performed on three different tips of CVC. The results showed that the PLI increases as a power function of the flow rate independent of the type of CVC. This study evidenced that the higher the blood flow rate used in the catheter, the greater the potential for thrombus formation. The PLI computed at the catheter outlet presented higher values when compared to the values computed at the vein outlet indicating that the blood flow through the CVC arterial lumen presents a proportionally larger thrombogenic potential when compared to the blood flow that leaves the vein towards the atrium. This finding may have consequences for clinical practice, since there is no specific flow value recommended in the catheter when the hemodialysis machine is turned on, and with this equation it was possible to demonstrate the thrombogenic potential that the flow rate can possibly offer.
Highlights
Native arteriovenous fistula (AVF) placement is the preferred form of permanent access, central venous catheters (CVC) remains the initial access for the majority of hemodialysis patients (Kennard et al 2017, Fulker et al 2017, Marques et al 2017)
The values of platelet lysis index (PLI) calculated at the catheter outlets have greater quantitative importance in the analyzed CVCs than those calculated at the vein outlets
It is a fact that regions of higher shear rate are consistent with regions of high PLI, but it is simpler to predict thrombogenic potential based on PLI, since it incorporates the time of exposure with each shear stress (Haniel et al 2019)
Summary
Native arteriovenous fistula (AVF) placement is the preferred form of permanent access, central venous catheters (CVC) remains the initial access for the majority of hemodialysis patients (Kennard et al 2017, Fulker et al 2017, Marques et al 2017). CVC are discouraged due to high rates of infectious, thrombotic complications and malfunction (Kennard et al 2017). To achieve adequate effectiveness during an average dialysis treatment of 4 hours, a CVC blood pump velocity of a minimum of 100 to 300 mL/min has to be set (Petridis et al 2017, Clark et al 2015b). The variation in the minimum flow values, depends on the type of CVC, place of insertion and degree of chronic renal disease. Several authors have suggested various CVC designs to ensure an optimal high blood flow rate and a long-lasting catheter (Marques et al 2017, Sutherland et al 2018)
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