<i>In vitro</i> recirculation evaluation of step-tip blood dialysis catheters based on a pulsatile flow right atrium model_West China Medical Journal

Authors：

ZHA Lei ¹ , YANG Yang ² , CHEN Chong ³ , CHEN Yu ² ,  XIONG Yan ¹ ,  ZHANG Ling ³

1. School of Mechanical Engineering, Sichuan University, Chengdu, Sichuan 610065, P. R. China;
2. Provincial Key Laboratory of Biomechanical Engineering, Sichuan University, Chengdu, Sichuan 610065, P. R. China;
3. Department of Nephrology and Institute of Kidney Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

XIONG Yan, Email: xy@scu.edu.cn; ZHANG Ling, Email: zhanglinglzy@163.com

Keywords：

Hemodialysis catheter; step-tip catheter; recirculation; right atrium model; in vitro evaluation

DOI：

10.7507/1002-0179.202606108

Video：

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Objective To construct an anatomical pulsatile flow right atrium in vitro evaluation platform to quantify the effects of dialysis flow rate, catheter arteriovenous port spacing, and tip position on the recirculation rate of step-tip dialysis catheters. Methods Based on CT image-derived 3D printed right atrium model, an in vitro pulsatile circulation loop was established. The recirculation rate was measured using dye tracing-ultraviolet spectrophotometry. Results A decrease in dialysis flow rate, an increase in port spacing, and the catheter tip penetrating deeper into the right atrium all increased the recirculation rate. When the arteriovenous port was fixed at 15 mm and the tip was located at the junction of the atrium and ventricle, the recirculation rates were 31.32%±4.06%, 26.49%±3.89%, and 16.17%±4.14% at dialysis flow rates of 100, 200, and 400 mL/min, respectively. When the flow rate was fixed at 400 mL/min, the recirculation rates were 16.17%±4.14%, 17.96%±5.96%, 21.68%±2.11%, and 29.74%±7.11% with the port spacing 15, 20, 25, and 30 mm, respectively. When the spacing was fixed at 15 mm and the catheter tip was moved from the superior vena cava to the right atrium, the recirculation rate increased from 6.93%±1.06% to 21.73%±4.21%. Conclusions The pulsatile fluid external model can accurately quantify the recirculation performance of step-tip catheters. Compared to the steady-state registration standards, the test results are more in line with the real in vivo environment, providing a standardized evaluation method for dialysis catheter registration testing, structural optimization, and clinical catheter placement.

Citation： ZHA Lei, YANG Yang, CHEN Chong, CHEN Yu, XIONG Yan, ZHANG Ling. In vitro recirculation evaluation of step-tip blood dialysis catheters based on a pulsatile flow right atrium model. West China Medical Journal, 2026, 41(7): 1084-1088. doi: 10.7507/1002-0179.202606108 Copy

1.	Saran R, Robinson B, Abbott KC, et al. US Renal data system 2019 annual data report: epidemiology of kidney disease in the United States[J]. Am J Kidney Dis, 2020, 75(Suppl 1): A6-A7.
2.	El Khudari H, Ozen M, Kowalczyk B, et al. Hemodialysis catheters: update on types, outcomes, designs and complications[J]. Semin Intervent Radiol, 2022, 39(1): 90-102.
3.	Zeraati A, Beladi Mousavi SS, et al. A review article: access recirculation among end stage renal disease patients undergoing maintenance hemodialysis[J]. Nephrourol Mon, 2013, 5(2): 728-732.
4.	Kousoula V, Georgianos PI, Mavromatidis K, et al. Reversed connection of cuffed, tunneled, dual-lumen catheters with increased blood flow rate maintains the adequacy of delivered dialysis despite the higher access recirculation[J]. Int Urol Nephrol, 2019, 51(10): 1841-1847.
5.	Level C, Lasseur C, Chauveau P, et al. Performance of twin central venous catheters: influence of the inversion of inlet and outlet on recirculation[J]. Blood Purif, 2002, 20(2): 182-188.
6.	Heaton CED, Espino DM. An experimental right atrium platform to assess recirculation in hemodialysis catheters[J]. J Mech Med Biol, 2024, 24(10): 2450027.
7.	Cho S, Lee J, Park SC, et al. Development of in-vitro pulsatile flow generator for evaluating the performance of hemodialysis catheters[J]. Rev Sci Instrum, 2023, 94(4): 044102.
8.	Silverstein DM, Trerotola SO, Clark T, et al. Clinical and regulatory considerations for central venous catheters for hemodialysis[J]. Clin J Am Soc Nephrol, 2018, 13(12): 1924-1932.
9.	Owen DG, de Oliveira DC, Qian S, et al. Impact of side-hole geometry on the performance of hemodialysis catheter tips: a computational fluid dynamics assessment[J]. PLoS One, 2020, 15(8): e0236946.
10.	Ling XC, Lu HP, Loh EW, et al. A systematic review and meta-analysis of the comparison of performance among step-tip, split-tip, and symmetrical-tip hemodialysis catheters[J]. J Vasc Surg, 2019, 69(4): 1282-1292.
11.	趙希梅, 游健康, 劉浩, 等. 微創血管介入手術導管輔助機器人自整定模糊 PID 控制[J]. 中國生物醫學工程學報, 2014, 33(1): 123-127.
12.	Sato Y, Yanagisawa K, Hachitani Y, et al. Effects of the tip structure of temporary indwelling catheters on blood recirculation at various blood flow rates and diameters of the mock blood vessel[J]. J Vasc Access, 2024, 25(2): 481-489.
13.	鄢建軍, 嚴賀, 張南, 等. 超聲稀釋法對頸內靜脈血液透析導管流量及再循環率的測定[J]. 護理研究, 2012, 26(10): 894-895.
14.	Carson RC, Kiaii M, MacRae JM. Urea clearance in dysfunctional catheters is improved by reversing the line position despite increased access recirculation[J]. Am J Kidney Dis, 2005, 45(5): 883-890.
15.	Senécal L, Saint-Sauveur E, Leblanc M. Blood flow and recirculation rates in tunneled hemodialysis catheters[J]. ASAIO J, 2004, 50(1): 94-97.
16.	吳灝, 蘇紅, 黃軍悅, 等. 不同血液透析留置導管流量及再循環監測[J]. 第二軍醫大學學報, 2007, 28(8): 921-923.
17.	Lee YK, Huh WS, Kang WH, et al. Is it true that the shorter distance between needles, the more recirculation in hemodialysis?[J]. Kidney Res Clin Pract, 2002, 21(5): 742-748.
18.	Tal MG, Peixoto AJ, Crowley ST, et al. Comparison of side hole versus non side hole high flow hemodialysis catheters[J]. Hemodial Int, 2006, 10(1): 63-67.
19.	Engstrom BI, Horvath JJ, Stewart JK, et al. Tunneled internal jugular hemodialysis catheters: impact of laterality and tip position on catheter dysfunction and infection rates[J]. J Vasc Interv Radiol, 2013, 24(9): 1295-1302.
20.	Vesely TM, Ravenscroft A. Hemodialysis catheter tip design: observations on fluid flow and recirculation[J]. J Vasc Access, 2016, 17(1): 29-39.

1. Saran R, Robinson B, Abbott KC, et al. US Renal data system 2019 annual data report: epidemiology of kidney disease in the United States[J]. Am J Kidney Dis, 2020, 75(Suppl 1): A6-A7.
2. El Khudari H, Ozen M, Kowalczyk B, et al. Hemodialysis catheters: update on types, outcomes, designs and complications[J]. Semin Intervent Radiol, 2022, 39(1): 90-102.
3. Zeraati A, Beladi Mousavi SS, et al. A review article: access recirculation among end stage renal disease patients undergoing maintenance hemodialysis[J]. Nephrourol Mon, 2013, 5(2): 728-732.
4. Kousoula V, Georgianos PI, Mavromatidis K, et al. Reversed connection of cuffed, tunneled, dual-lumen catheters with increased blood flow rate maintains the adequacy of delivered dialysis despite the higher access recirculation[J]. Int Urol Nephrol, 2019, 51(10): 1841-1847.
5. Level C, Lasseur C, Chauveau P, et al. Performance of twin central venous catheters: influence of the inversion of inlet and outlet on recirculation[J]. Blood Purif, 2002, 20(2): 182-188.
6. Heaton CED, Espino DM. An experimental right atrium platform to assess recirculation in hemodialysis catheters[J]. J Mech Med Biol, 2024, 24(10): 2450027.
7. Cho S, Lee J, Park SC, et al. Development of in-vitro pulsatile flow generator for evaluating the performance of hemodialysis catheters[J]. Rev Sci Instrum, 2023, 94(4): 044102.
8. Silverstein DM, Trerotola SO, Clark T, et al. Clinical and regulatory considerations for central venous catheters for hemodialysis[J]. Clin J Am Soc Nephrol, 2018, 13(12): 1924-1932.
9. Owen DG, de Oliveira DC, Qian S, et al. Impact of side-hole geometry on the performance of hemodialysis catheter tips: a computational fluid dynamics assessment[J]. PLoS One, 2020, 15(8): e0236946.
10. Ling XC, Lu HP, Loh EW, et al. A systematic review and meta-analysis of the comparison of performance among step-tip, split-tip, and symmetrical-tip hemodialysis catheters[J]. J Vasc Surg, 2019, 69(4): 1282-1292.
11. 趙希梅, 游健康, 劉浩, 等. 微創血管介入手術導管輔助機器人自整定模糊 PID 控制[J]. 中國生物醫學工程學報, 2014, 33(1): 123-127.
12. Sato Y, Yanagisawa K, Hachitani Y, et al. Effects of the tip structure of temporary indwelling catheters on blood recirculation at various blood flow rates and diameters of the mock blood vessel[J]. J Vasc Access, 2024, 25(2): 481-489.
13. 鄢建軍, 嚴賀, 張南, 等. 超聲稀釋法對頸內靜脈血液透析導管流量及再循環率的測定[J]. 護理研究, 2012, 26(10): 894-895.
14. Carson RC, Kiaii M, MacRae JM. Urea clearance in dysfunctional catheters is improved by reversing the line position despite increased access recirculation[J]. Am J Kidney Dis, 2005, 45(5): 883-890.
15. Senécal L, Saint-Sauveur E, Leblanc M. Blood flow and recirculation rates in tunneled hemodialysis catheters[J]. ASAIO J, 2004, 50(1): 94-97.
16. 吳灝, 蘇紅, 黃軍悅, 等. 不同血液透析留置導管流量及再循環監測[J]. 第二軍醫大學學報, 2007, 28(8): 921-923.
17. Lee YK, Huh WS, Kang WH, et al. Is it true that the shorter distance between needles, the more recirculation in hemodialysis?[J]. Kidney Res Clin Pract, 2002, 21(5): 742-748.
18. Tal MG, Peixoto AJ, Crowley ST, et al. Comparison of side hole versus non side hole high flow hemodialysis catheters[J]. Hemodial Int, 2006, 10(1): 63-67.
19. Engstrom BI, Horvath JJ, Stewart JK, et al. Tunneled internal jugular hemodialysis catheters: impact of laterality and tip position on catheter dysfunction and infection rates[J]. J Vasc Interv Radiol, 2013, 24(9): 1295-1302.
20. Vesely TM, Ravenscroft A. Hemodialysis catheter tip design: observations on fluid flow and recirculation[J]. J Vasc Access, 2016, 17(1): 29-39.

West China Medical Journal

In vitro recirculation evaluation of step-tip blood dialysis catheters based on a pulsatile flow right atrium model

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