Reducing Use of Physical Assessment and Ultrasound for More Efficient Diagnosis of Catheter-Related Thrombosis with Vinous CRT Catheter

by Vikram Chatterjee

Coauthors: Citations Citla Sridhar, Divyaswathi, et al. “Central Venous Catheter-Related Thrombosis in Children and Adults.” Thrombosis Research, vol. 187, 2020, pp. 103–112., https://doi.org/10.1016/j.thromres.2020.01.017. Verso, Melina, and Giancarlo Agnelli. “Venous Thromboembolism Associated with Long-Term Use of Central Venous Catheters in Cancer Patients.” Journal of Clinical Oncology, vol. 21, no. 19, 2003, pp. 3665–3675., https://doi.org/10.1200/jco.2003.08.008. Wall, Caroline, et al. “Catheter-Related Thrombosis: A Practical Approach.” Journal of the Intensive Care Society, vol. 17, no. 2, 2015, pp. 160–167., https://doi.org/10.1177/1751143715618683. Acknowledgements Thank you to Dr. Sharief Taraman and Dr. Anthony Chang for their continued support and encouragement throughout the CHOC MI4 internship. Additionally, thank you to Dr. Timothy Flannery and Dr. Sony Ton for helping develop this idea and design.

Medical Devices & Digital Health

Background
Central venous catheters (CVCs) appear extensively in critical care and often in patients with high risk factors for venous thromboembolism. A common complication of CVC insertion is catheter-related thrombosis (CRT), occurring at reported rates of 14-18% in all patients (Verso and Agnelli). Additionally, CRT accounts for 50-80% of deep vein thrombosis (DVT) in children, making it an urgent issue in pediatric care (Sridhar et al.). These cases can result in infection, post-thrombotic syndrome, pulmonary embolism, and significant delays in treatment—leading to poor clinical outcomes.

While the currently-used duplex ultrasound is a reliable tool for observing blood flow, it is only used after CRT is suspected clinically. The typical symptoms of swelling or venous distention are often assessed subjectively, lacking empirical evidence to indicate thrombosis. In addition, the majority of CRT patients are asymptomatic and do not present the signs for ultrasound imaging to confirm a thrombotic event (Wall et al.). As such, available technology in the status quo limits clinicians’ ability to diagnose catheter-related thrombosis effectively.

Methodology
The Vinous CRT Catheter innovates the central venous catheter itself. The assessment of venous pressures is performed through microsensors, made of a copper-nickel alloy and coated with synthetic biomaterial, placed in 0.5 cm intervals alongside the CVC. A combination of miniaturized strain gauge sensors and transducers allows for consistent monitoring of venous pressures, which are then converted to electrical signals for processing. Pressures outside of the optimal range will be indicated by a color change and alarm on the computer.

However, pressure measurements alone fail to specify whether the high pressure is due to an obstruction (kink) in the circuit or a venous thrombus. Thus, the catheter’s exterior contains alternating, weak positive and negative magnetic nanoparticles (covered with inert biomaterial) between the pressure sensors. When the tube kinks, these particles will communicate an electromagnetic signal to the processing computer. The computer receives signals from both pressure sensors and magnetic sensors, and an artificial intelligence model utilizes this data to determine if turbulent flow is due to thrombus obstruction or simple bending of the tube. As this information is transmitted through the computer, clinicians can respond appropriately and choose to replace the catheter or reposition the patient.

Conclusion
The lack of clinical guidelines and diagnostic technology make CRT a critical issue, especially for intensive care units. CVCs can remain for weeks or months, and many patients receive treatments several times a day—posing an ever-present risk for CRT. The severity of this complication necessitates an innovative solution, and the Vinous CRT Catheter implements evidence-based screening to reduce the risk of undetected thrombosis immensely.

Implementation in in-patient settings will allow clinicians to focus on patients’ primary conditions rather than devote time and resources towards detecting a thrombus. Additional training will not be required as it provides diagnostic information while functioning like a regular catheter; the intuitive design allows it to be implemented into healthcare settings immediately. Ultimately, the Vinous CRT Catheter will increase ICU efficiency, improve clinical outcomes, and accelerate treatment plans for patients.