ESPN 53rd Annual Meeting

ESPN 2021


 
A computational approach to investigate malfunctions of central venous lines in children
CLAUDIA BRUNO 1 RAYAN MOUMNEH 1 EMILIE SAUVAGE 1 ALBERTO C.L. REDAELLI 2 IAN SIMCOCK 3 SILVIA SCHIEVANO 1 CLAUDIO CAPELLI 1 RUKSHANA SHROFF 3

1- UNIVERSITY COLLEGE LONDON, INSTITUTE OF CARDIOVASCULAR SCIENCE (LONDON, UK)
2- DEPARTMENT OF ELECTRONICS, INFORMATION AND BIOENGINEERING, POLITECNICO DI MILANO (MILAN, ITALY)
3- GREAT ORMOND STREET HOSPITAL FOR CHILDREN, NHS FOUNDATION TRUST (LONDON, UK)
 
Introduction:

Central venous lines (CVLs) for haemodialysis (HD) in children are associated with frequent complications leading to inadequate dialysis and change of devices in nearly half the patients. Computational fluid dynamics (CFD) can be used to characterize the haemodynamic of CVLs. We studied CVLs commonly used in children to investigate the correlation between fluid-dynamics parameters and clinical outcomes.

Material and methods:

Four models of CVLs of varying design and sizes (6.5F, 8F, 10F and 14F) were reconstructed from microCT images. CFD analyses were set up to simulate CVL working conditions in anatomical models of superior vena cava. Haemodynamic features including velocity fields, shear stresses, and platelet lysis index (PLI) were analysed, and CFD simulations compared to clinical data on catheter dysfunction from our Centre. 

 

Results:

Analysis of velocity fields identified presence of jets through the side holes (Figure 1a) and areas of recirculation and stagnation in all the designs, especially when used in arterial configurations. Side-holes played a crucial role in fluid exchange in all the design but in the 8F design. In this case area of stagnation were found in proximity of the side-holes. Highest presence of shear stresses >10Pa were also found in the 8Fr CVL while highest PLI in the 10F model. The anatomical model showed an increased disturbance of the flow (Figure 1b) and wall shear stresses. CFD results were in accordance with the clinical data which showed a higher recurrence rate of complications for the 8Fr and 10Fr CVLs (Figure 1c).

 

Figure 1     a) Velocity field plotted in the 10F CVL; b) Velocity pathlines within the anatomical model after catheter insertion; c) Dysfunction-free survival graph of CVLs at our Centre.

Conclusions:

This study provides novel characterization of fluid-dynamics of CVLs that may guide future improved CVL design.