Leakage of central venous catheter locking fluid by hemodynamic transport.
Leakage of central venous catheter locking fluid by hemodynamic transport.
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血流动力学输送导致中心静脉导管锁定液体渗漏。
DOI：
10.1097/mat.0000000000000089
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Aliseda,Alberto
中科院分区：
文献类型：
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作者：
McGah,PatrickM;Gow,KennethW;Aliseda,Alberto
中心静脉导管在不使用时通常用抗凝液填充，通常是肝素化的生理盐水，称为锁定液。然而，锁紧液的使用与已知的风险有关，因为锁的“泄漏”。本文提出了一个新的假说来解释锁液泄漏：该泄漏是由于原地导管尖端周围的血液流动引起的平流和扩散传质所致。在以往体外实验的基础上，假设渗漏机制是由较重的血液和较轻的锁定液之间的浮力驱动的流体运动。目前的假设被一个简单的一维传质模型和更复杂的理想化导管的三维计算血流动力学模拟所证实。结果预测，最初，快速(<；10秒)平流为主的阶段，可能耗尽高达10%的初始锁定，随后是缓慢扩散限制阶段，预测在48小时内，额外的1-2%的泄漏。目前的结果预测的泄漏率与体内公布的数据更一致，与浮力假说的预测相比，后者往往严重高估了泄漏率。
Central venous catheters are often filled when not in use with an anticoagulating fluid, usually heparinized saline, known as the locking fluid. However, the use of the locking fluid is associated with known risks because of “leakage” of the lock. A new hypothesis is proposed here to explain the lock fluid leakage: that the leakage is due to advective and diffusive mass transfer by blood flow around the catheter tip in situ. On the basis of previous in vitro experiments, the leakage mechanism has been hypothesized to be fluid motion driven by buoyancy forces between the heavier blood and the lighter locking fluid. The current hypothesis is justified by a simple one-dimensional mass transfer model and more sophisticated three-dimensional computational hemodynamic simulations of an idealized catheter. The results predict an initial, fast (< 10 seconds) advection-dominated phase, which may deplete up to 10% of the initial lock, followed by a slow diffusion-limited phase which predicts an additional 1–2% of leakage during a 48 hour period. The current results predict leakage rates that are more consistent with published in vivo data when compared with the buoyancy hypothesis predictions, which tend to grossly overestimate leakage rates.