{"title":"优化输液流模式以减少静脉壁创伤:使用改良离轴导管尖端开口的探索性研究。","authors":"Amit Bahl, S Matthew Gibson, Alexis Walton","doi":"10.2147/TCRM.S479846","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":null,"pages":null},"PeriodicalIF":2.8000,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11380876/pdf/","citationCount":"0","resultStr":"{\"title\":\"Optimizing Infusate Flow Patterns for Minimizing Vein Wall Trauma: An Exploratory Study with a Modified off-Axis Catheter Tip Opening.\",\"authors\":\"Amit Bahl, S Matthew Gibson, Alexis Walton\",\"doi\":\"10.2147/TCRM.S479846\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":22977,\"journal\":{\"name\":\"Therapeutics and Clinical Risk Management\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2024-09-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11380876/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Therapeutics and Clinical Risk Management\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.2147/TCRM.S479846\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"Pharmacology, Toxicology and Pharmaceutics\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Therapeutics and Clinical Risk Management","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2147/TCRM.S479846","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"Pharmacology, Toxicology and Pharmaceutics","Score":null,"Total":0}
Optimizing Infusate Flow Patterns for Minimizing Vein Wall Trauma: An Exploratory Study with a Modified off-Axis Catheter Tip Opening.
Objective: 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.
期刊介绍:
Therapeutics and Clinical Risk Management is an international, peer-reviewed journal of clinical therapeutics and risk management, focusing on concise rapid reporting of clinical studies in all therapeutic areas, outcomes, safety, and programs for the effective, safe, and sustained use of medicines, therapeutic and surgical interventions in all clinical areas.
The journal welcomes submissions covering original research, clinical and epidemiological studies, reviews, guidelines, expert opinion and commentary. The journal will consider case reports but only if they make a valuable and original contribution to the literature.
As of 18th March 2019, Therapeutics and Clinical Risk Management will no longer consider meta-analyses for publication.
The journal does not accept study protocols, animal-based or cell line-based studies.