Study of catheter designs and drug mixing processes using 2D steady numerical simulations

Investigating the Hydrodynamics of Intravenous Drug Infusions

One of the most common reported adverse events for intravenous (IV) infusions are infusion site reactions, ranging from redness and pain at the site of infusion to thrombophlebitis.  The connection between drug infusion and what drives these adverse events is not well understood. To aid in understanding these phenomena, it is crucial to accurately characterize the evolving hemodynamic environment of the infusion site when developing new intravenous formulations, as too rapid dilution may cause precipitation in the vein, while too little dilution might contribute to phlebitis. In this study, a Large-Eddy Simulation (LES) turbulence modeling inside a Computational Fluid Dynamics (CFD) framework has been used to simulate the flow and mixing characteristics of an infusion entering the bloodstream. This work represents the first such study reporting transient flow fields for intravenous infusions using LES CFD simulations with a realistic non-Newtonian blood model. The output of the CFD model closely resembled the flow and mixing patterns generated in benchtop tests for infusions into a blood analogue and water as the venous fluid across a wide range of flow rates.  These models were then investigated further to compare how changes to the fluid rheology model, needle orientation and needle position within the vein resulted in altered mixing regimes at different flow rates.

Navigation of guidewires and catheters in the body during intervention procedures: a review of computer-based models

Guidewires and catheters are used during minimally invasive interventional procedures to traverse in vascular system and access the desired position. Computer models are increasingly being used to predict the behavior of these instruments. This information can be used to choose the right instrument for each case and increase the success rate of the procedure. Moreover, a designer can test the performance of instruments before the manufacturing phase. A precise model of the instrument is also useful for a training simulator. Therefore, to identify the strengths and weaknesses of different approaches used to model guidewires and catheters, a literature review of the existing techniques has been performed. The literature search was carried out in Google Scholar and Web of Science and limited to English for the period 1960 to 2017. For a computer model to be used in practice, it should be sufficiently realistic and, for some applications, real time. Therefore, we compared different modeling techniques with regard to these requirements, and the purposes of these models are reviewed. Important factors that influence the interaction between the instruments and the vascular wall are discussed. Finally, different ways used to evaluate and validate the models are described. We classified the developed models based on their formulation into finite-element method (FEM), mass-spring model (MSM), and rigid multibody links. Despite its numerical stability, FEM requires a very high computational effort. On the other hand, MSM is faster but there is a risk of numerical instability. The rigid multibody links method has a simple structure and is easy to implement. However, as the length of the instrument is increased, the model becomes slower. For the level of realism of the simulation, friction and collision were incorporated as the most influential forces applied to the instrument during the propagation within a vascular system. To evaluate the accuracy, most of the studies compared the simulation results with the outcome of physical experiments on a variety of phantom models, and only a limited number of studies have done face validity. Although a subset of the validated models is considered to be sufficiently accurate for the specific task for which they were developed and, therefore, are already being used in practice, these models are still under an ongoing development for improvement. Realism and computation time are two important requirements in catheter and guidewire modeling; however, the reviewed studies made a trade-off depending on the purpose of their model. Moreover, due to the complexity of the interaction with the vascular system, some assumptions have been made regarding the properties of both instruments and vascular system. Some validation studies have been reported but without a consistent experimental methodology.

A simple catheter-vessel model for MR assessment of drug distribution in arteries and optimization of catheter design for intraarterial infusion therapy

PURPOSE

To investigate the efficacy of a new catheter-vessel model for MRI to evaluate drug distribution and to optimize catheter design for intraarterial infusion therapy

MATERIALS AND METHODS

The model consisted of a hepatic artery simulant tube through which blood simulant water flowed continuously and a water cistern. Catheters were inserted into the tube and a gadolinium contrast medium was injected at rates suitable for angiographic or computed tomographic evaluation and commensurate with the clinical drug infusion rate. Axial images of the tube were obtained with a 0.2-T scanner and gradient echo technique. Preliminary studies and catheter tests were conducted. The points at which drug and water were completely mixed were defined as the site with uniform enhancement nearest the catheter tip.

RESULTS

Flip angle and gadolinium concentrations were optimized at 90 degrees, and at 62.5 and 500 mM for the high and low infusion rates, respectively. Drug distribution near the catheter tips was clearly visualized. The drug was mixed in shorter distances via the slit side-hole than the end- or side-hole catheters, and the smaller diametrical than the larger at either rate.

CONCLUSION

This model appeared to be effective for evaluation of drug distribution and optimization of catheter design.

Effects of Diffusion Coefficients and Struts Apposition Using Numerical Simulations for Drug Eluting Coronary Stents

In the context of drug eluting stent, we present two-dimensional numerical models of mass transport of the drug in the wall and in the lumen to study the effect of the drug diffusion coefficients in the three principal media (blood, vascular wall, and polymer coating treated as a three-compartment problem) and the impact of different strut apposition configurations (fully embedded, half embedded, and not embedded). The different conditions were analyzed in terms of their consequence on the drug concentration distribution in the arterial wall. We apply the concept of the therapeutic window to the targeted vascular wall region and derive simple metrics to assess the efficiency of the various stent configurations. Although most of the drug is dispersed in the lumen, variations in the blood flow rate within the physiological range of coronary blood flow and the diffusivity of the drug molecule in the blood were shown to have a negligible effect on the amount of drug in the wall. Our results reveal that the amount of drug cumulated in the wall depends essentially on the relative values of the diffusion coefficients in the polymer coating and in the wall. Concerning the strut apposition, it is shown that the fully embedded strut configuration would provide a better concentration distribution.

A virtual reality simulator for remote interventional radiology: concept and prototype design

We present a virtual reality simulator to realize interventional radiology (IR) procedures remotely. The simulator contains two subsystems: one at the local site and the other at the remote site. At the local site, the interventional radiologist interacts with a three-dimensional (3-D) vascular model extracted from the patient's data and inserts IR devices through the Motion Tracking Box (MTB), which converts physical motion (translation and rotation) of IR devices into digital signal. This signal is transferred to the Actuator Box (AB) at the remote site that drives the IR devices in the patient. The status of the IR devices is subsequently fed back to the local site and displayed on the vascular model. To prove the concept, the prototype developed employs a physical angiography phantom (mimicking the patient) and its corresponding 3-D digital model. A magnetic tracking system provides information about positioning of the IR devices in the phantom. The initial results are encouraging. The AB controlled remotely drives IR devices with resolution of 0.00288 mm/step in translation and 0.079 deg/step in rotation.