A Chemo-poroelastic Analysis of Mechanically Induced Fluid and Solute Transport in an Osteonal Cortical Bone

It is well known that transport of nutrients and wastes as solute in bone fluid plays an important role in bone remodeling and damage healing. This work presents a chemo-poroelastic model for fluid and solute transport in the lacunar-canalicular network of an osteonal cortical bone under cyclic axial mechanical loading or vascular pressure. Analytical solutions are obtained for the pore fluid pressure, and fluid and solute velocities. Numerical results for fluid and calcium transport indicate that under a cyclic stress of 20 MPa, the magnitudes of the fluid and calcium velocities increase with an increase in the loading frequency for the frequency range considered (≤ 3 Hz) and peak at the inner boundary. The peak magnitude of calcium velocity reaches 18.9 μm/s for an osteon with a permeability of 1.5 × 10^-19 m² under a 3 Hz loading frequency. The magnitude of calcium velocity under a vascular pressure of 50 mmHg is found to be two orders of magnitude smaller than that under the mechanical load. These results have the potential to be important in understanding fundamental aspects of cortical bone remodeling as transport characteristics of calcium and other nutrients at the osteon scale influence bone metabolism.

Variability in alignment of central venous pressure transducer to physiologic reference point in the intensive care unit-A descriptive and correlational study

BACKGROUND

The phlebostatic axis is the most commonly used anatomical external reference point for central venous pressure measurements. Deviation in the central venous pressure transducer alignment from the phlebostatic axis causes inadequate pressure readings, which may affect treatment decisions for critically ill patients in intensive care units.

AIM

The primary aim of the study was to assess the variability in central venous pressure transducer levelling in the intensive care unit. We also assessed whether patient characteristics impacted on central venous pressure transducer alignment deviation.

METHODS

A sample of 61 critical care nurses was recruited and asked to place a transducer at the appropriate level for central venous pressure measurement. The measurements were performed in the intensive care unit on critically ill patients in supine and Fowler's positions. The variability among the participants using eyeball levelling and a laser levelling device was calculated in both sessions and adjusted for patient characteristics.

RESULTS

A significant variation was found among critical care nurses in the horizontal levelling of the pressure transducer placement when measuring central venous pressure in the intensive care unit. Using a laser levelling device did not reduce the deviation from the phlebostatic axis. Patient characteristics had little impact on the deviation in the measurements.

CONCLUSION

The anatomical external landmark for the phlebostatic axis varied between critical care nurses, as the variation in the central venous pressure transducer placement was not reduced with a laser levelling device. Standardisation of a zero-level for vascular pressures should be considered to reduce the variability in vascular pressure readings in the intensive care unit to improve patient treatment decisions. Further studies are needed to evaluate critical care nurses' knowledge and use of central venous pressure monitoring and whether assistive tools and/or routines can improve the accuracy in vascular pressure measurements in intensive care units.