title: Convective Leakage Makes Heparin Locking of Central Venous Catheters Ineffective Within Seconds: Experimental Measurements in a Model Superior Vena Cava.
abstract: Central venous catheters (CVCs), placed in the superior vena cava (SVC) for hemodialysis or chemotherapy, are routinely filled while not in use with heparin, an anticoagulant, to maintain patency and prevent thrombus formation at the catheter tip. The heparin-locking procedure, however, places the patient at risk for systemic bleeding, as heparin is known to leak from the catheter into the blood stream. We provide evidence from detailed in vitro experiments that shows the driving mechanism behind heparin leakage to be convective-diffusive transport due to the pulsatile flow surrounding the catheter. This novel mechanism is supported by experimental planar laser-induced fluorescence (PLIF) and particle image velocimetry (PIV) measurements of flow velocity and heparin transport from a CVC placed inside a model SVC inside a pulsatile flow loop. The results predict an initial, fast (<10 s), convection-dominated phase that rapidly depletes the concentration of heparin in the near-tip region, the region of the catheter with side holes. This is followed by a slow, diffusion-limited phase inside the catheter lumen, where the concentration is still high, that is insufficient at replenishing the lost heparin concentration in the near-tip region. The results presented here, which are consistent with previous in vivo estimates of 24 hour leakage rates, predict that the concentration of heparin in the near-tip region is essentially zero for the majority of the interdialytic phase, rendering the heparin locking procedure ineffective.
authors.affiliation: From the *Department of Mechanical Engineering, and †Seattle Children's Hospital and Department of Surgery, University of Washington, Seattle, Washington.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Barbour
authors.forename: Patrick M
authors.initials: PM
authors.lastname: McGah
authors.forename: Chin H
authors.initials: CH
authors.lastname: Ng
authors.forename: Alicia M
authors.initials: AM
authors.lastname: Clark
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Gow
authors.forename: Alberto
authors.initials: A
authors.lastname: Aliseda
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage*; D062905:Central Venous Catheters / Q000009:adverse effects*; D004058:Diffusion; D006439:Hemodynamics; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D008955:Models, Cardiovascular; D012039:Regional Blood Flow / Q000502:physiology; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*; D014683:Vena Cava, Superior / Q000502:physiology / Q000503:physiopathology*
chemical_list: D000925:Anticoagulants; D006493:Heparin