An ex-vivo evaluation of vascular catheters for continuous hemofiltration

Objectives: To measure outflow and inflow hydraulic resistance in double-lumen catheters used for hemofiltration under standardized laboratory conditions. Setting: ICU Laboratory of tertiary unit. Methods: Heparinized spent red cells diluted in polygeline solution to a constant hematocrit of 32% at 37°C were pumped using a standard Prisma M60 circuit through several hemofiltration catheters. Blood pump speed was increased and decreased in steps of 30 mL/min (30, 60, 90, 120, 150, and 180 mL/min) and catheter outflow and inflow pressures recorded and used to define the pressure flow relationship (line of hydraulic resistance) for each. Results: Double-lumen catheters posed different resistances to outflow or inflow. Among the <15cm long catheters, the 11.5 Fr Quinton-Mahurkar (0.56 mmHg/mL/min) catheter offered the least resistance to outflow, while the Medcomp 11.5 Fr catheter offered the least resistance to inflow (0.78 mmHg/mL/min). Among the >19 cm long catheters, the 13.5 Fr Vascath Niagara catheter showed the lowest blood flow resistance to both outflow (0.63 mmHg/mL/min) and inflow (0.83 mmHg/mL/min). Longer catheters did not pose statistically greater resistance to both outflow and inflow. Resistance to inflow was consistently greater than resistance to outflow (p = 0.003). Overall, the Prisma M60 blood circuit alone accounted for 40% of the total extracorporeal circuit blood flow resistance. Conclusions: Proprietary hemofiltration catheters have variable resistance to blood flow under standard ex-vivo conditions. This ex-vivo information might be useful to clinicians in guiding their choice of catheters for clinical use.