Hemolytic reactions mechanically induced by kinked hemodialysis lines

Sweet, Stephen; McCarthy, Sharon; Steingart, Richard; Callahan, Tina

doi:10.1016/s0272-6386(96)90550-8

Cited by 56 publications

(46 citation statements)

References 11 publications

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“…A variety of damage mechanisms have been proposed, including collapse of individual microbubbles causing shockwaves or high-velocity liquid jets (Brujan et al 2005; Evan et al 2002), bubble cloud collapse (Ikeda et al 2006), microstreaming-induced shear forces and acoustic streaming (Sweet et al 1996), or combinations of these effects. The interaction between cavitation and cells is the focus of our future mechanistic study.…”

Section: Discussionmentioning

confidence: 99%

Noninvasive Thrombolysis Using Pulsed Ultrasound Cavitation Therapy – Histotripsy

Maxwell¹,

Cain²,

Duryea³

et al. 2009

Ultrasound in Medicine & Biology

220

166

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Clinically available thrombolysis techniques are limited by either slow reperfusion (drugs) or invasiveness (catheters), and carry significant risks of bleeding. In this study, the feasibility of using histotripsy as an efficient and non-invasive thrombolysis technique was investigated. Histotripsy fractionates soft tissue through controlled cavitation using focused, short, high-intensity ultrasound pulses. In-vitro blood clots formed from fresh canine blood were treated by histotripsy. The treatment was applied using a focused 1-MHz transducer, with 5-cycle pulses at a pulse repetition rate of 1 kHz. Acoustic pressures varying from 2 -12 MPa peak negative pressure were tested. Our results show that histotripsy can perform effective thrombolysis with ultrasound energy alone. Histotripsy thrombolysis only occurred at peak negative pressure ≥6 MPa when initiation of a cavitating bubble cloud was detected using acoustic backscatter monitoring. Blood clots weighing 330 mg were completely broken down by histotripsy in 1.5 -5 minutes. The clot was fractionated to debris with >96% weight smaller than 5 μm diameter. Histotripsy thrombolysis treatment remained effective under a fast, pulsating flow (a circulatory model) as well as in static saline. Additionally, we observed that fluid flow generated by a cavitation cloud can attract, trap, and further break down clot fragments. This phenomenon may provide a non-invasive method to filter and eliminate hazardous emboli during thrombolysis.

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Section: Discussionmentioning

confidence: 99%

Noninvasive Thrombolysis Using Pulsed Ultrasound Cavitation Therapy – Histotripsy

Maxwell¹,

Cain²,

Duryea³

et al. 2009

Ultrasound in Medicine & Biology

220

166

View full text Add to dashboard Cite

show abstract

“…Various factors lead to hemolysis. These include those arising through oxidizing agents and reducing agents, osmolar insults, thermal and mechanical injury or excessive uremia at initiation of dialysis (Abtahi et al, 2007;Sweet et al, 1996) Oxidizing agents result from contamination of the dialysate with copper, zinc, chloramine or nitrate. These agents lead to hemolysis by establishing oxidant damage in erythrocytes (Kjellstrand et al, 1974;Carlson&Shapiro 1970;Calderaro & Heller 2001;Blomfield et al, 1969).…”

Section: Hematological Complicationsmentioning

confidence: 99%

“…Thermal injury is observed when dialysate temperature reaches levels higher than body temperature (Berkes et al, 1975). Mechanical injury may develop in association with maloccluded blood pumps, arterial line collapse, kinked or obstructed hemodialysis tubing of the use of subclavian hemodialysis catheter (Abtahi et al, 2007;Sweet et al, 1996) Acute hemolytic reaction symptoms include malaise, nausea, chest pain, shortness of breath, abdominal pain, back pain, emesis, cyanosis and headache. A positive pink test (pinkappearing serum) is seen in massive hemolysis.…”

Section: Hematological Complicationsmentioning

confidence: 99%

Acute Complications of Hemodialysis

Özkan¹,

Ulusoy²

2011

Technical Problems in Patients on Hemodialysis

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“…Extracellular hypertonicity, usually seen with diabetic hyperglycemia23) or hypertonic fluid administration24), causes hyperkalemia on the basisof convective [K] efflux from cells and insulin deficiency. Lastly, severe exercise25) and hemolysis in the course of hemodialysis26) release large amount of [K] into the ECF compartment and may cause severe hyperkalemia.…”

Section: Hyperkalemia On Maintenance Hemodialysismentioning

confidence: 99%

Potassium Balances in Maintenance Hemodialysis

2013

Electrolyte Blood Press

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Potassium is abundant in the ICF compartment in the body and its excretion primarily depends on renal (about 90%), and to a lesser extent (about 10%) on colonic excretion. Total body potassium approximated to 50mmol/kg body weight and 2% of total body potassium is in the ECF compartment and 98% of it in the intracellular compartment.Dyskalemia is a frequent electrolyte imbalance observed among the maintenance hemodialysis patients. In case of hyperkalemia, it is frequently "a silent and a potential life threatening electrolyte imbalance" among patients with ESRD under maintenance hemodialysis. The prevalence of hyperkalemia in maintenance HD patients was reported to be about 8.7-10%. Mortality related to the hyperkalemia has been shown to be about 3.1/1,000 patient-years and about 24% of patients with HD required emergency hemodialysis due to severe hyperkalemia. In contrast to the hyperkalemia, much less attention has been paid to the hypokalemia in hemodialysis patients because of the low prevalence under maintenance hemodialysis patients. Severe hypokalemia in the hemodialysis patients usually was resulted from low potassium intake (malnutrition), chronic diarrhea, mineralocorticoid use, and imprudent use of K-exchange resins. Recently, the numbers of the new patients with advanced chronic kidney disease undergoing maintenance hemodialysis are tremendously increasing worldwide. However, the life expectancy of these patients is still much lower than that of the general population. The causes of excess mortality in these patients seem to various, but dyskalemia is a common cause among the patients with ESRD undergoing hemodialysis.

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Hemolytic reactions mechanically induced by kinked hemodialysis lines

Cited by 56 publications

References 11 publications

Noninvasive Thrombolysis Using Pulsed Ultrasound Cavitation Therapy – Histotripsy

Noninvasive Thrombolysis Using Pulsed Ultrasound Cavitation Therapy – Histotripsy

Acute Complications of Hemodialysis

Potassium Balances in Maintenance Hemodialysis

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