SCIENTIFIC RePoRTs | (2018) 8:3441 | DOI:10.1038/s41598-018-21617-1
The mechanistic causes of
peripheral intravenous catheter
failure based on a parametric
, Peter J. Carr
, Lachlan J. Kelsey
, Andrew C. Bulmer
, Samantha Keogh
& Barry J. Doyle
Peripheral intravenous catheters (PIVCs) are the most commonly used invasive medical device,
yet up to 50% fail. Many pathways to failure are mechanistic and related to uid mechanics, thus
can be investigated using computational uid dynamics (CFD). Here we used CFD to investigate
typical PIVC parameters (infusion rate, catheter size, insertion angle and tip position) and report the
hemodynamic environment (wall shear stress (WSS), blood damage, particle residence time and venous
stasis volumes) within the vein and catheter, and show the eect of each PIVC parameter on each
hemodynamic measure. Catheter infusion rate has the greatest impact on our measures, with catheter
orientation also playing a signicant role. In some PIVC congurations WSS was 3254 times higher
than the patent vein, and blood damage was 512 times greater, when compared to control conditions.
Residence time is geometry-dependent and decreases exponentially with increasing insertion angle.
Stasis volume decreased with increasing infusion rate and, to a lesser degree, insertion angle. Even
without infusion, the presence of the catheter changes the ow eld, causing low velocity recirculation
at the catheter tip. This research demonstrates how several controllable factors impact important
mechanisms of PIVC failure. These data, the rst of their kind, suggest limiting excessive infusion rates
e insertion of a peripheral intravenous catheter/cannula (PIVC) is the most common invasive medical proce-
dure worldwide, with current annual estimates of over one billion devices used
. However, up to 50% of success-
fully inserted devices require removal due to failure prior to their clinical need being fullled
Clinical investigations describing failure mechanisms of PIVCs have been published
, resulting in interven-
tional studies to update techniques for the securement of PIVCs
and, in time, clinical guidelines
. Current PIVCs
have two predominant failure ‘categories’; failure of insertion and failure aer time in situ. Insertion failures, are
largely inuenced by the inserting clinician (assuming manufacturing standards are met)
In situ failure is associated with a triad of denitions some which are not mutually exclusive; (i) inltration,
i.e. where the infusion inadvertently escapes the vein lumen and/or is infused into the subcutaneous tissues
occlusion, also referred to as blocked, where ushing or aspirating from the PIVC is not possible
; and (iii) phle-
bitis and/or thrombophlebitis
leading to infection (either local or systemic), with systemic infection being par-
ticularly serious. Importantly, phlebitis is not always associated with thrombus formation, and can occur within
the catheter potentially occluding due to brin deposition around the access port without any thrombus evident
(catheter occlusion without vein occlusion), however, the two mechanisms are strongly inter-related. If phlebitis
Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and
Centre for Medical Research, The University of Western Australia, Perth, Australia.
School of Engineering, The
University of Western Australia, Perth, Australia.
Emergency Medicine, Faculty of Health and Medical Sciences,
The University of Western Australia, Perth, Australia.
The Alliance for Vascular Access Teaching and Research
Group, Menzies Health Institute Queensland, Grith University, Brisbane, Australia.
School of Medical Science
and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.
School of Nursing, Institute
of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
BHF Centre for
Cardiovascular Science, The University of Edinburgh, Edinburgh, UK. Correspondence and requests for materials
should be addressed to B.J.D. (email: email@example.com)
Received: 18 September 2017
Accepted: 7 February 2018
Published: xx xx xxxx