High Blood flow Rates with Adjustment of Needle Diameter do not Increase Hemolysis during Hemodialysis Treatment

Techert, F.; Techert, Simone; Woo, Lee Seoung; Beck, Werner; Lebsanft, Heike; Wizemann, V.

doi:10.1177/112972980700800406

Cited by 14 publications

(11 citation statements)

References 16 publications

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“…Unknown substances in uremic plasma (71) or oxidative stress (72) may contribute to this effect while parathyroid hormone can be excluded (73). An increase of free plasma hemoglobin has been reported in uneventful treatments although the postdialysis values were still within the normal range (74).…”

Section: Reported Hemolysis Rates For Blood Pumps Used In Hemodialysismentioning

confidence: 99%

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Red Blood Cell Damage from Extracorporeal Circulation in Hemodialysis

Polaschegg¹

2009

Seminars in Dialysis

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Blood damage is an unavoidable side effect of extracorporeal circulation. The effects of blood damage on patients' hematocrit and erythropoietin requirement as well as other potential side effects have not been studied for uneventful treatments. Comparing long nocturnal dialysis with regular 4-hour, three times per week dialysis allows for the conclusion that the influence of blood damage caused by extracorporeal circulation is small compared with biochemical effects. Acute hemolysis is one of the few remaining mechanical problems of dialysis. Acute hemolysis is caused by obstructions within the extracorporeal circuit caused by manufacturing errors, kinking of blood tubing or user errors, or by a combination of excessive flow and improper cannula or catheter dimensions. The risk of acute hemolysis can be further reduced by industrial quality control, better design of dialysis equipment, and hemodialysis machine control. Adverse effects caused by chronic mechanical hemolysis need to be studied.

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Section: Reported Hemolysis Rates For Blood Pumps Used In Hemodialysismentioning

confidence: 99%

“…No difference of hemolysis markers were reported when 15 g cannulas at 400 ml/minute blood flow were compared with 16 g cannulas at 300 blood flow (75) and when switching from 250 ml/minute blood flow with 17 g cannulas to 500 ml/minute blood flow with 14 g cannulas (74).…”

Section: Reported Hemolysis Rates For Blood Pumps Used In Hemodialysismentioning

confidence: 99%

Red Blood Cell Damage from Extracorporeal Circulation in Hemodialysis

Polaschegg¹

2009

Seminars in Dialysis

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“…3). Therefore, we did not endeavor to detect hemolysis at PreAP less negative than −200 mm Hg in vivo according to the previous report (18). For ethical reasons, we could not prescribe a higher flow rate to induce more negative pressure in HD patients due to the potential complication of inadequate dialysis and hemolysis, given our results.…”

Section: Discussionmentioning

confidence: 95%

Re‐evaluation of Pre‐pump Arterial Pressure to Avoid Inadequate Dialysis and Hemolysis: Importance of Prepump Arterial Pressure Monitoring in Hemodialysis Patients

et al. 2015

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Prepump arterial pressure (PreAP) is monitored to avoid generating excessive negative pressure. The National Kidney Foundation K/DOQI clinical practice guidelines for vascular access recommend that PreAP should not fall below -250 mm Hg because excessive negative PreAP can lead to a decrease in the delivery of blood flow, inadequate dialysis, and hemolysis. Nonetheless, these recommendations are consistently disregarded in clinical practice and pressure sensors are often removed from the dialysis circuit. Thus far, delivered blood flow has been reported to decrease at values more negative than -150 mm Hg of PreAP. These values have been analyzed by an ultrasonic flowmeter and not directly measured. Furthermore, no known group has evaluated whether PreAP-induced hemolysis occurs at a particular threshold. Therefore, the aim of this study was to clarify the importance of PreAP in the prediction of inadequate dialysis and hemolysis. By using different diameter needles, human blood samples from healthy volunteers were circulated in a closed dialysis circuit. The relationship between PreAP and delivered blood flow or PreAP and hemolysis was investigated. We also investigated the optimal value for PreAP using several empirical monitoring methods, such as a pressure pillow. Our investigation indicated that PreAP is a critical factor in the determination of delivered blood flow and hemolysis, both of which occured at pressure values more negative than -150 mm Hg. With the exception of direct pressure monitoring, commonly used monitoring methods for PreAP were determined to be ineffective. We propose that the use of a vacuum monitor would permit regular measurement of PreAP.

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“…Techert and colleagues compared RBC damage, by measuring free haemoglobin (Hb) concentrations whilst using high flow rates of 500 mL/min through a 14 Gauge cannula versus flow of 250 mL/min through a 17 Gauge needle. They demonstrated that higher blood flow rates can be applied without an increased haemolysis risk provided that needle sizes are adapted accordingly.…”

Section: Causesmentioning

confidence: 99%

Haemolysis in haemodialysis

Tharmaraj

Kerr

2017

Nephrology

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ABSTRACT:Haemolysis in haemodialysis, although rare in current times, is associated with significant mortality and morbidity. As such prompt recognition, treatment, analysis of root cause and correction of underlying causative factors is crucial. Dialysate, extracorporeal circuit and patient related factors all contribute to haemolysis risk. Haemolysis can manifest with non-specific signs and symptoms including but not restricted to hypertension, nausea, pain (abdominal, chest, back) and dyspnoea. It may present acutely during the dialysis session or may take a protracted course. Potential life threating consequences include; hyperkalaemia induced cardiac arrhythmias, profound anaemia and associated acute coronary events and respiratory distress, and severe necrotizing pancreatitis. Chronic haemolysis results in impaired endothelial function thus contributing to the long-term cardiovascular risk profile in haemodialysis patients. Stringent national and international standards, technological advancements in membrane and dialysis equipment design, dialyser purification methods and water treatment systems have greatly reduced the incidence of haemolysis. Despite these improvements recognition of haemolysis risk and ongoing clinical vigilance is important.

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High Blood flow Rates with Adjustment of Needle Diameter do not Increase Hemolysis during Hemodialysis Treatment

Abstract: Higher blood flow rates can be applied without an increased hemolysis risk provided that needle sizes are adapted accordingly.

Cited by 14 publications

References 16 publications

Red Blood Cell Damage from Extracorporeal Circulation in Hemodialysis

Red Blood Cell Damage from Extracorporeal Circulation in Hemodialysis

Re‐evaluation of Pre‐pump Arterial Pressure to Avoid Inadequate Dialysis and Hemolysis: Importance of Prepump Arterial Pressure Monitoring in Hemodialysis Patients

Haemolysis in haemodialysis

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