Pump Catheter Research Articles

Evaluation and optimization of interventional blood pump based on hydraulic performances and hemocompatibility performances

This study was designed to investigate the effects of hemodynamic environment and design factors on the hydraulic performance and hemocompatibility of interventional blood pumps using computational fluid dynamics methods combined with specialized mathematical models. These analyses assessed how different hemodynamic environments (such as support mode and artery size) and blood pump configurations (including entrance/exit blade angles, rotor diameter, blade number, and diffuser presence) affect hydraulic performance indicators (rotational speed, flow rate, pressure head, and efficiency) and hemocompatibility indicators (bleeding, hemolysis, and thrombosis). Our findings indicate that higher perfused flow rates necessitate greater rotational speeds, which, in turn, reduce both efficiency and hemocompatibility. As the artery size increases, the hydraulic performance of the pump improves but at the cost of worsening hemocompatibility. Among the design parameters, optimal configurations exist that balance both hydraulic performance and hemocompatibility. Notably, a configuration without a diffuser demonstrated better hydraulic performance and hemocompatibility compared to one with a diffuser. Further analysis revealed that flow losses primarily contribute to the degradation of hydraulic performance and deterioration of hemocompatibility. Shear stress was identified as the major cause of blood damage in interventional blood pumps, with residence time having a limited impact. This study comprehensively explored the effects of operating environment and design parameters on catheter pump performance using a multi-faceted blood damage model, providing insights into related complications from a biomechanical perspective. These findings offer valuable guidance for engineering design and clinical treatment.

Innovations in Pain Management for Abdominoplasty Patients: A Systematic Review

Background/Objectives: Abdominoplasties are prevalent surgical procedures for improving lower abdominal contours, necessitating effective pain management. Insufficient management can increase opioid usage, dependency risks, and adverse effects. This review investigates various strategies in abdominoplasty pain management, aiming to reduce opioid dependence and improve patient care. Methods: A comprehensive systematic literature search (MEDLINE, Cochrane, PubMed, Web of Science, EMBASE) was conducted, spanning from their inception to January 2024, using keywords such as ‘abdominoplasty’ and ‘postoperative pain management’. Included studies focused on nonopioid interventions in adults, encompassing various study designs. Non-English publications and those not meeting outcome criteria were excluded. Bias in studies was assessed using specific tools for randomized and non-randomized trials. Results: Thirty-five studies, published between 2005 and 2024, were included, involving 3636 patients with an average age of 41.8. Key findings highlighted the effectiveness of transversus abdominis plane blocks in reducing opioid use and pain. Pain pump catheters also showed promise in improving pain management and reducing opioid dependency. Local anesthetics demonstrated varying degrees of efficacy, while other alternatives like ketamine and NSAIDs successfully reduced postoperative pain and opioid requirements. The bias assessment of the RCTs revealed “low” and “some concerns” ratings, indicating a need for more detailed methodology reporting and management of missing data. The cohort studies generally attained “moderate” risks of bias, primarily due to confounding variables and outcome data reporting. Conclusions: Nonopioid analgesics show potential in postoperative pain management for abdominoplasties, but further research is needed to confirm their effectiveness and optimize patient care.

84: Percutaneous transvalvular counterpulsation pump catheter significantly unloads left ventricle in a goat model of cardiogenic shock under extracorporeal membrane oxygenation support

84: Percutaneous transvalvular counterpulsation pump catheter significantly unloads left ventricle in a goat model of cardiogenic shock under extracorporeal membrane oxygenation support

A Peristaltic Pump to Improve Bladder Emptying and Irrigation in Patients Who Use Clean Intermittent Catheterization

Background: Neurogenic bladder patients who intermittently catheterize may have systems that drain slowly and incompletely. These limitations can lead to urinary tract infections and bladder stone formation and be time consuming. We hypothesize that a catheter accessory device could improve drainage, reduce residual bladder volume, and save time. Methods: A yearlong collaboration between an undergraduate biomedical engineering student design team and client mentors from the pediatric urology department led to an evaluation of solutions to enhance emptying of bladders that require intermittent catheterization. Students performed market analysis, identified design requirements, generated design concepts, conducted usability testing, and constructed alpha and beta prototypes verified through benchtop experimentation during the yearlong project. Prototypes were verified using a phantom bladder model built from a compliant stress ball with an attached catheter and placed under an external pressure of 5 cm H 2 O. Tests were conducted to measure the diff erence between passive drainage and device-assisted drainage at various bladder volumes and catheter sizes. Eight student peers compared passive emptying, irrigating, and aspirating a phantom bladder model using the prototype or syringe to assess the usability of the device. Results: We developed a pump that interfaces with commercially available catheters. The pump housing was designed and 3D printed. Fluid can be moved bi-directionally with a battery-powered peristaltic pump and microcontroller. The pump has a built-in current sensing threshold with an automatic shutoff safety mechanism. Testing results showed that for all bladder volumes and catheter sizes, the pump emptied more completely and drained between 1.6 and 6.3 times faster when compared to passive drainage. Usability feedback showed that the pump required less time to irrigate the bladder and was preferred when compared to the manual syringe technique. Conclusions: This portable catheter pump improves phantom bladder emptying by increasing flow rate, decreasing residual volume, and making irrigation easier. Future design improvements will work to implement safety mechanisms and miniaturize the pump. This project demonstrates the feasibility of a catheter accessory device to improve patient quality of life and the ability for understudied clinical problems to be addressed through collaborations between capstone engineering design teams and physicians.

Preoperative management using Impella support for acute aortic dissection with left coronary malperfusion: a case report

BackgroundAcute aortic dissection (AAD) with impaired perfusion of the left coronary artery has a poor prognosis, even after urgent radical aortic surgery, due to extensive myocardial damage. Although Impella, a microaxial-flow catheter pump, is useful in managing acute myocardial infarction, it is generally contraindicated in patients with AAD because it is an intra-aortic device and the aortic structure is compromised in these cases. Here, we introduce a novel intervention that allowed a planned aortic repair after managing circulation using Impella and venoarterial extracorporeal membrane oxygenation in a case of AAD with left main trunk malperfusion.Case presentationA 40-year-old man presented with cardiogenic shock. Percutaneous coronary intervention was performed to address left main trunk obstruction using an intra-aortic balloon pump; however, circulatory instability persisted. The patient was transferred to our hospital after venoarterial extracorporeal membrane oxygenation. Impella CP™ was used to improve his circulatory status. However, a subsequent CT scan confirmed an AAD diagnosis. After 5 days of stable circulatory support, the patient underwent aortic root replacement and coronary artery bypass grafting.ConclusionsIn patients with AAD and coronary malperfusion, adjunctive circulatory management with Impella may be a valuable therapeutic option.

Hemorrhagic Shock Associated with a Subcutaneous Insulin Pump Catheter: First Time Reported Side Effect.

Continuous subcutaneous insulin infusion (CSII) systems, used to treat diabetes for over 40 years may improve glycemic control but also have rare major complications. We report the first hemorrhagic shock on the infusion site of an insulin pump, due to a rectus abdominis hematoma. An eighty-one years old woman with history of cardiovascular events and type 1 diabetes, presented with hemorrhagic shock due to a rectus abdominis hematoma rapidly constituted at the insulin injection site. The situation improved after conservative treatment (blood transfusions, IV fluids, replacement of the CSII with insulin injections). Contributive factors to this complication were overdose of anticoagulant, oversized insulin canula and cough. We recommend increased monitoring of patients using insulin pump with hemorrhagic risk factors. Specific education for the prevention and detection of signs of hemorrhage should lead patients to report this situation promptly, in order to avoid this life-threatening complication.

P10: CFD Simulation Of Thrombosis In A Catheter Pump Inside The Left Ventricle

Study: Catheter pumps are small axial flow assist devices indicated for temporary use for a variety of indications. Uniquely positioned within the circulation, the pump impeller and motor are situated in the ascending aorta, and blood is pumped from the left ventricle (LV) via a long angled inlet cannula. The interplay of pulsatile LV blood dynamics with hemocompatibility performance of a catheter pump is not well characterized. The purpose of this study is to conduct computational fluid dynamics (CFD) simulation that includes multifactorial and synergistic models of blood damage to a catheter pump within a virtual in-vivo environment to analyze its hemodynamics. Methods: A generic catheter pump whose shape is inspired by the Impella 5.0 is situated within a static geometry consisting of a semi-realistic LV and aorta. We apply bloodDamageFoam, an OpenFOAM-based CFD code, to predict the hemodynamic flow and blood damage generated by the pump operating at 20 kRPM. The thrombosis model includes seven biochemical and biophysical agonists and accounts for the effects of high shear stress induced activation of von Willebrand factor. Results: CFD predicted 4.43 LPM blood flow rate from the LV delivered into the aorta. Moderate levels of hemolysis were predicted. The thrombosis model showed moderate degrees of platelet deposition on the cage of the inlet cannula and within the catheter pump chamber. Because the LV in this simulation was not beating, unrealistically large regions of flow stagnation and high platelet activation were observed in the LV. To address this, realistic pulsatility of a dilated LV is currently being modeled. Our latest progress will be presented at the meeting.

Perfusionist removal of intra-aortic balloon pump catheters improves efficiency without an increase in complication rates.

The intra-aortic balloon pump (IABP) is one of the most utilized cardiac assist devices. Patients receiving IABP therapy are typically managed in high acuity clinical care areas with limited bed space and high demand. Our center instituted a certified clinical perfusionist (CCP) led initiative to remove IABP catheters in order to reduce IABP therapy time, hasten removal and improve efficiency. The purpose of the study is to compare outcomes for IABP removal by a certified clinical perfusionist to a physician. The primary outcome measures were site hematoma score and limb related complications. A survey was submitted to bedside nurses, managers/patient care coordinators, CCP's and physicians. The IABP quality assurance database was interrogated for the study. There were 350 patients eligible for inclusion. The cohort was well balanced between CCP (n = 284) and physician (n = 66) groups for patient demographics, indication, insertion specifics and type of medical intervention. The majority of patients had no bruise or hematoma with perfusionist (n = 246, 87%) or physician (n = 58, 88%) (p = 0.78) removal. The physician group demonstrated a higher rate of grade 3 hematomas (p = 0.03). There was no statistically significant difference between CCP and physician groups for limb complications and mortality. Survey results showed an improved efficiency in bed space allocation, physician workload and a decreased IABP support time. There is no difference in limb complications between perfusionist and physician removal of IABP catheters. The survey demonstrate an improvement in resource allocation and efficiency. A perfusionist led IABP removal program can be done safely and may help improve program efficiency.

Teaching images: intrathecal pump catheter aneurysm.

Teaching images: intrathecal pump catheter aneurysm.

Abstract 12221: Work Improvement With Novel Remote Monitoring System (Impella Connect) in Clinical Engineer Involving Acute Mechanical Circulatory Support

Introduction: Recent innovations in mechanical circulatory support (MCS) enable physicians to deal with challenging cases with cardiogenic shock. As the number of MCS has increased, the excessive workload of clinical engineers (CEs) who manage MCS has become a serious problem. To overcome such situation, we introduced innovative remote monitoring system of circulatory assist pump catheters (Impella) called Impella Connect (IC) from 2020, which allows medical staff to monitor driving status and alarms of Impella in their mobile devices. Here we reported our experience of IC and the safety and efficacy of our protocol using IC for management of Impella. Methods: We identified 63 Impella cases for cardiogenic shock from 2018 to 2021 in our institution. We utilized Impella 2.5/CP in 53 cases and Impella 5.0 in 10 cases depending on their hemodynamic condition. Before introducing IC (nIC period: n=17), CEs were responsible for Impella management in all time periods and needed to work overtime to manage devices in night time. However, after introducing IC (IC periods: n=46), CEs were responsible only in daytime and non-MCS expert medical stuff were responsible in night time supporting by CEs’ remote monitoring with IC. We retrospectively evaluated the safety and efficacy of our management using IC. Results: Impella insertion was performed emergently in all cases and the 34 cases (53.9 %) were inserted in night time. Average support time was 6.5±0.6 days (nIC 7.7 vs. 6.0 days). We encountered 13 device trouble in nIC periods (purge system in 8, pressure sensor in 4 and pump malfunction in 1) and 14 in IC periods (purge system in 9, pressure sensor in 3 and pump malfunction in 2). Device trouble requiring intervention was not significantly different in both periods (nIC/IC 10 vs. 11 cases, p=0.85) and adverse event related to delayed or inappropriate response was not observed in both periods. The average of overtime working hours of CEs per month was significantly decreasing in IC periods (53.1±16.8 vs. 8.6±2.6 hours per month, p<0.05). Conclusions: Our Impella management using novel remote monitoring system with Impella Connect was safe with no adverse events and effective to reduce overtime work of CEs, which resulted in work improvement of medical stuff involving MCS.

Stent Graft Placement for the Treatment of Hepatic Artery Injury in Patients with Cancer: Primary Patency and Clinical Outcomes

PurposeTo evaluate the safety, primary patency, and clinical outcomes of hepatic artery stent graft (SG) placement for vascular injuries. Materials and MethodsPatients treated with hepatic arterial SG placement for vascular injuries between September 2018 and September 2021 were reviewed. Data on demographic characteristics, indication, stent graft characteristics, antiplatelet/anticoagulant use, clinical success rate, complications, and type of follow-up imaging were collected. Follow-up images were reviewed by 2 independent reviewers to assess primary patency. A time-to-event analysis was performed. The median duration of stent graft patency was estimated using Kaplan-Meier curves. A Cox proportional hazard model was used to evaluate factors related to stent graft patency. ResultsThirty-five patients were treated with hepatic arterial SG placement, 11 for postoperative bleeds and 24 for hepatic artery infusion pump catheter–related complications. Clinical success was achieved in 32 (91%) patients (95% CI, 77–98). The median primary patency was 87 days (95% CI, 73–293). Stent grafts of ≥6-mm diameter retained patency for a longer duration than that with stent grafts of smaller diameters (6 mm vs 5 mm; hazard ratio, 0.35; 95% CI, 0.14–0.88; P = .026; and 7+ mm vs 5 mm; hazard ratio, 0.27; 95% CI, 0.09–0.83; P = .023). Anticoagulation/antiplatelet regimen was not associated with increased stent graft patency duration (P > .05). Only minor complications were reported in 2 (5.7%) patients. ConclusionsStent grafts can be used safely and effectively to treat injuries of the hepatic artery. Stent graft diameters of ≥6 mm seem to provide more durable patency.

S2856 Poke the Bear and Get the Claws: Life-Threatening Bleeding by Hepatic Artery Infusion Pump Fistula Managed by Over the Scope Clip Closure

Introduction: Hepatic artery infusion (HAI) pumps may be used for regional delivery of chemotherapy for treatment of colorectal cancer liver metastases. Complications are rare, but can include arterial thrombus and catheter dislocation. We present a case of duodenal fistula associated with hepatic artery infusion pump and subsequent closure with over the scope clip. Case Description/Methods: We present the case of a 57-year-old male with stage IV colon adenocarcinoma and liver metastasis who underwent placement of hepatic artery infusion (HAI) pump for local chemotherapy. 6 months later, he presented with 3 days of melena and fatigue with vitals demonstrating heart rate 129 bpm and blood pressure was 111/69 mmHg. Notably, hemoglobin was 9.1 g/dL, down from a baseline of 14.4 g/dL. He was admitted to the surgical oncology service and gastroenterology was consulted for suspected upper GI bleed. Esophagogastroduodenoscopy (EGD) performed the day after admission revealed suspected fistula in the duodenal bulb. Bleeding resolved with proton pump inhibitor therapy alone with plan for outpatient repeat endoscopy. 1 month later the patient presented with anemia, melena and acute blood loss. Repeat EGD demonstrated a bleeding duodenal bulb lesion and hemostasis was achieved by placement of a 12/6t over the scope clip placement. Subsequent CTA scan identified the hepatic artery infusion pump tip adjacent to over the scope clip in the proximal duodenum with no extravasation suggesting resolution of bleeding after clip placement. (Figure) Discussion: We present a rare case of duodenal bleeding due to hepatic artery infusion catheter tip dislocation. A large single center experience of 544 patients over a 15-year period demonstrated the most common complications from HAI to include arterial thrombosis (6%), catheter occlusion/dislodgement (6%) and extrahepatic perfusion (3%)1. Furthermore, literature search for cases from 1975-2022 reveals fewer than 10 cases with this bleeding complication. In this case we demonstrate the successful use of an OTSC to manage bleeding associated from the fistula created by the infusion pump catheter between hepatic artery and duodenal bulb.Figure 1.: A: Index endoscopy showing fistula in the bulb of the duodenum. B: Subsequent endoscopy with bleeding fistula. C: Fistula closure and successful hemostasis with over the scope clip. D: CT scan showing clip with close approximation to the hepatic artery infusion catheter tip.

Can a Mixture of Insulin and a Nonsteroidal Anti-inflammatory Drug Prolong Insulin Pump Catheter Wear Time in Adults With Type 1 Diabetes?

Continuous subcutaneous insulin infusion systems (CSIIs) are commonly used by patients with diabetes. According to manufacturer and health agency recommendations, patients are advised to change their infusion set after 2 to 3 days (1). This rule of thumb is largely based on observational data suggesting that longer wear time is associated with increased catheter malfunctions, adverse events (AEs) at the insertion site and subsequent metabolic complications (2–4). However, in an international survey of 14,015 type 1 or type 2 diabetes CSII users from Europe and North America, over 18% of patients reported wearing their catheters for longer than the recommended time (5).

First-in-Man Use of the Percutaneous 10F Reitan Catheter Pump for Cardiorenal Syndrome.

Cardiorenal syndrome worsens outcome in patients with decompensated chronic heart failure, and complicates recompensation by medical therapy. Mechanical circulatory support has the potential to improve renal function, and likely mitigates diuretic resistance in patients with severe cardiorenal syndrome. The Reitan catheter pump (RCP) is a novel temporary percutaneous circulatory support system for reducing cardiac afterload and increasing renal preload. Here, we report on the first-in-man use of the 10F-version of the RCP device, which was associated with favorable effects on hemodynamics and diuresis. Further investigation to evaluate safety and efficacy of this promising approach is warranted.

Radiology of Intra-Aortic Balloon Pump Catheters.

Radiographs play an important role in ascertaining appropriate placement of the intra-aortic balloon pump catheter. This imaging essay highlights correct and incorrect positioning of these catheters, with emphasis on the variability of radiopaque markers used with different catheter models and on axillary versus femoral catheter placement routes. Keywords: Conventional Radiography, CT, Percutaneous, Cardiac, Vascular, Aorta, Anatomy, Cardiac Assist Devices, Catheters © RSNA, 2022.

Percutaneous Mechanical Circulatory Support Pump Catheter; Clinical Practice and Challenge

Percutaneous Mechanical Circulatory Support Pump Catheter; Clinical Practice and Challenge

Impact of Circulatory Support Pump Catheter (Impella) Use for Mechanical Complications following Acute Myocardial Infarction

Impact of Circulatory Support Pump Catheter (Impella) Use for Mechanical Complications following Acute Myocardial Infarction

Impaction of a Percutaneous Heart Pump in Iliac Artery and Its Removal Using Snare

In the process of forceful pulling out of an entangled placement guidewire, the percutaneous heart pump catheter folded in on itself and, on withdrawal farther down in the aorta, became impacted in the right common iliac artery. We describe the removal of this impacted catheter with the help of snare. (Level of Difficulty: Advanced.)

Low Rate of Intrathecal Baclofen Pump Catheter-Related Complications: Long-Term Study in Over 100 Adult Patients Associated With Reinforced Catheter

Intrathecal baclofen (ITB) is a cost-effective therapy for patients with severe spasticity. The most common complications are catheter-related complications (CRCs) including kinking/occlusion, blockage, migration, fracture, disconnection, and CSF leak. Our objective was to determine the CRC rate in a large cohort of adults with newly implanted ITB pump systems with polymer reinforced silicone catheters. This is a retrospective study of a prospectively maintained database consisting of patients who had undergone implantation of ITB pump systems with Ascenda (Medtronic, Minneapolis) catheters from 2013 to 2020. Over this seven-year period, 141 patients underwent ITB pump system implantations; 126 of which had a minimum of one-year follow-up. The 126 patients with a minimum of one year follow-up (average 43 month; range 12-89), had an average age of 51 years (63% male). Severe spasticity was due to spinal cord injury (38%), traumatic brain injury (15%), cerebral palsy (13%), multiple sclerosis (11%), stroke (10%), and other (13%). Nine (7.1%) CRCs occurred in 7 (5.6%) patients (median 6 mo. post-implant): 5 intrathecal catheter occlusions (range 3-52 months post-implant), two fractures in one patient (6 months), one disconnection at the catheter pump interface (2 months), and one due to kinking at 84 months No migrations occurred. Reported CRCs have been high for ITB pump systems. Ours is the first large cohort, long-term study of CRCs related to reinforced catheters; additionally, our low CRC rate compares favorably to previously published data. Thus, implantation of reinforced catheters may be associated with a low CRC rate.

Prepontine placement of an intrathecal baclofen pump catheter for treatment of dystonia

Background: Cerebral palsy with medically refractory spasticity and dystonia is a condition that often benefits from intrathecal baclofen pump therapy to treat these symptoms. In this case report, an intracranial baclofen catheter was placed in the prepontine space to improve withdrawal symptoms in a patient unable to undergo new lumbar catheter placement due to infection.Case Description: A 22-year-old female with past medical history of cerebral palsy presented with baclofen pump failure and was unable to undergo placement of a new lumbar baclofen catheter due to an infection in her lower back precluding safe and efficacious catheter placement. It was decided the patient would benefit from intrathecal baclofen administered in the prepontine space as a means to avoid a lumbar catheter and thus bypass this prior infection site. An endoscopic third ventriculostomy (ETV) was performed with the endoscope and the distal end of the baclofen pump catheter was fed through this ETV into the prepontine space. Placement in the prepontine space was confirmed by a follow-up head computed tomography. There was a significant improvement in autonomic symptoms and spasticity. By postoperative day 5, the patient was surgically and medically cleared for discharge.Conclusion: In cases of severe baclofen withdrawal due to dysfunctional pumps, immediate reversal is preferred but may not be feasible due to factors such as infection. This case report has demonstrated that prepontine catheter placement can be effective for the administration of baclofen to reverse withdrawal symptoms in these types of patients.