| Contrast experiment of in vitro ejection and distribution of multi-side holes infusion catheter under different infusion modes Objective:To compare the difference of the in vitro ejection and distribution of infusion fluid at different infusion rates in continuous infusion and pulsed infusion model with multi-side holes infusion catheters.Methods:Three kinds of multi-side holes infusion catheters commonly used in clinical practice were selected to compare the efficacy of the in vitro ejection and distribution in different modes.The specific methods were as follows:1.The continuous infusion mode was simulated and the tracer was pumped into three kinds of multi-sides holes infusion catheter by intelligent infusion pump.The preset infusion rates were 10 ml/h,20 ml/h,and 30 ml/h,respectively,and continuous infusion duration was 30 min.The distribution of tracer in the distal and proximal segments of each catheter under different rates was observed,all progress was captured by HD cameras.The distribution was compared,then the optimum infusion rate was chosen.2.The pulsed infusion mode was simulated and the tracer was injected into three kinds of multi-sides holes infusion catheter by high-pressure injector.The total volume of injected liquid was 5ml,and the preset injection rates was 1ml/s,3ml/s,and 5ml/s,respectively.The spray and distribution of tracer in the distal and proximal segments of each catheter under different rates was observed,all progress was captured by HD cameras.The spray and distribution was compared and analyzed,then the optimum injection rate was chosen.The results of this experiment was qualitative analysis.The distribution characteristics of the tracer at the distal and proximal segments in the effective infusion section(the distal segment was the head of the catheter and the proximal segment was caudal of the catheter)was described by have(+)or no(-).The degree of spray were classified by poor(-),medium(+),and excellent,(++).The results of all the experiments were judged by the three vice director or cheif physicians of interventional department.Results:1.In the continuous infusion mode,when the infusion rate was 10 ml/h,the tracer of the three kinds of multi-side holes infusion catheters were distributed at the proximal segment of the catheter.When the infusion rate was 20 ml/h,the tracer distribution of the three kinds of multi-side holes infusion catheters were still mainly proximal segment of the catheter.when the infusion rate was 30 ml/h,the tracer of the three kinds of multi-side holes infusion catheters were distributed at the distal and proximal segments of the catheter.Therefore,the optimum infusion rate was 30 ml/h.2.In the pulsed infusion mode,when the injection rate was 1ml/s,the liquid of three kinds of multi-side holes infusion catheter had not reached the jet state and the distribution was uneven..When the injection rate was 3ml/s,the liquid of three kinds of multi-side holes infusion catheter had reached the spray state and the distribution was evenly.When the injection rate was 5ml/s,the liquid of three kinds of multi-side holes infusion catheters had reached perfect spray state and the distribution was more even.Hence,the optimum injection rate was 5 ml/s.Conclusion:1.In the continuous infusion mode,the distribution of fluids in vitro at different infusion rates is unlike in multi-side holes infusion catheter.And when the infusion rate is faster,the distribution of liquid is more uniform in vitro.When the infusion rate is 30ml/h,the liquid distribution of the multi-side holes infusion catheter was more uniform in vitro.2.In the pulse mode,the injection and distribution of liquid in vitro the multi-side holes infusion catheter at different rates are unlike.When the injection rate is faster,the injection and distribution of the liquid in vitro are better.When the injection rate is 5ml/s,the distribution and spray of the liquid in vitro is optimal.3.The fluid distribution in the pulsed infusion mode of multi-side holes infusion catheter is more uniform than in the continuous infusion mode.Catheter-directed Thrombolysis in treatment of acute iliofemoral Deep Vein Thrombosis with Multi-side holes infusion catheter in different infusion modes:a Clinical ResearchObjective:To compare the clinical effectiveness and safety of catheter-directed thrombolysis(CDT)in the treatment of acute iliofemoral deep venous thrombosis(IFDVT)between continuous infusion and intermittent pulsed infusion mode.Methods:Our prospective study included 22 patients with documented acute IFDVT.Exclusion criteria included contraindications to the use of anticoagulation,thrombolysis,contrast media and rejection of inferior vena cava filter(IVCF)placement to prevent fatal pulmonary embolism(PE)during treatment.According to different infusion modes,patients were divided into two groups,12 patients in continuous infusion group(Group A,n=12)and 10 patients in intermittent pulsed infusion group(Group B,n=10).Dpend on the extent of thrombus,the appropriate multi-side holes infusion was selected(the catheters used are FOUTIAN infusion catheters)for CDT.In Group A,Urokinase(UK)was pumped continuously for 0.5million units per day with an infusion rate of 30 ml/h.In Group B,UK was pulsed with 0.125 million units for four times a day,each infusion was injected manually with 5 ml per injection and completed within 60 minutes.Coagulation and blood routine also were recorded during the duration of CDT each day.After the treatment of CDT,percutaneous transluminal angioplasty(PTA)or stent implantation was required for patients who had severe iliac vein stenosis.Thrombolysis should be stopped as follows :(1)the thrombus is completely or mostly dissolved,(2)Serious bleeding complications happened during CDT,(3)There was no effect or the thrombosis had no change in more than 2 consecutive venography.The reduction degree of limb swelling,thrombus removal at 48-hour thrombolysis and the end of treatment,infusion duration,the total UK dose and complications we all recorded.Statistical analysis was performed with use of SPSS software(version24.0SPSS).Measurement data were reported as mean ± SD.Inter-group comparisons of measurement data were performed using independent t test,Enumeration data were used to Fisher's exact probabilities test.P<0.05 was used as a threshold for statistical significance.Results:1.The limbs edema reduction degree of Group A and Group B had no significant differences in 24-hour thrombolysis(thigh: 2.29±0.87 cm vs.2.35±0.63 cm,P=0.861;calf: 1.42±0.82 cm vs.1.47±0.88 cm,P=0.884)and the end of treatment(thigh :6.58±1.22 cm vs.6.42±2.05 cm,P=0.819;calf :6.04±1.91 cm vs.6.15±2.24,P=0.904)2.The thrombus clearance in 24-hour thrombolysis and the end of treatment were similar(34.58±12.33% vs.37.00±17.67%,P=0.710;94.58±8.91% vs.93.00±8.23%,P=0.672).There was no significant difference of thrombus removal level between Group A and B(P=0.666).3.The duration of CDT and the total UK dose in Group A had no not statistically significant in two group(6.67±1.16 d vs.6.60±1.17 d,P=0.895;333.33±57.74 million units vs.330.00±58.69 million units,P=0.895)4.There were no serious complications such as PE and hemorrhoea in 22 patients.Bleeding events were encountered in 2(16.7%)patients and 3(30.0%)patients in Group A and B,there was no significant difference of incidence of complications between the two group(P=0.624).Conclusion:The clinical efficacy and safety of CDT in the treatment of acute IFDVT under continuous infusion and intermittent pulsed infusion are positive,and there is no significant difference between the two infusion modes,more further research is necessary. |
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