Ultrasound detection of microembolic signals in hemodialysis accesses

Woltmann, David J.; Fatica, Richard; Rubin, Jonathan M.; Weitzel, William F.

doi:10.1016/s0272-6386(00)70207-1

Cited by 26 publications

(23 citation statements)

References 12 publications

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“…Droste and colleagues also noted that the number of microembolic signals in the subclavian vein were higher during hemodiafiltration than during hemodialysis (11). In one study, the microembolic signals were interpreted either due to emboli or to air bubbles (12). The authors interpreted that these emboli were derived from the roller pump.…”

Section: Discussionmentioning

confidence: 99%

The Sensor in the Venous Chamber Does Not Prevent Passage of Air Bubbles During Hemodialysis

Stegmayr¹,

Forsberg

Jönsson³

et al. 2007

Artificial Organs

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We previously showed, in vitro, that micro bubbles pass the air trap without inducing an alarm. The aim was to investigate if micro bubbles bypass the detector during hemodialysis (HD). During HD (40 patients, 47 HD sessions, 231 measurements), an ultrasound detector was fixed just after the venous air trap. Micro bubble size was measured in the range from 5 microm up to >42.5 microm. Blood flow was at a mean 346 mL/min (SD +/- 57). The mean of all micro bubbles per minute, without inducing an alarm, was at start 128 (range 0-769). Measurements revealed the presence of micro bubbles in all of the series and in 90% of the measurements. There was no difference between start and end of the same dialyses. There was a correlation between blood flow and extent of micro bubbles for the smaller sizes and the sum of all bubbles (r > or = 0.29, P < or = 0.026). Micro bubbles passed the air trap without alarming. Most bubbles were approximately 5 microm.

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Section: Discussionmentioning

confidence: 99%

The Sensor in the Venous Chamber Does Not Prevent Passage of Air Bubbles During Hemodialysis

Stegmayr¹,

Forsberg

Jönsson³

et al. 2007

Artificial Organs

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“…However, as the mesh size is generally around 200 mm, passage of microemboli is possible. 10,11 The clinical sequelae associated with their passage into the circulation has not received study. While the majority of dialysis systems utilize drip chambers in the extracorporeal circuit, the Genius system (Fresenius Medical Care, Bad Homburg, Germany) uses blood tubing sets without bubble traps or filters.…”

Section: Tubing Setsmentioning

confidence: 99%

“…It is well recognized that air‐blood interfaces are associated with clot formation and passage of gross clots back to the patient is prevented by the presence of a mesh filter in the base of the venous drip chamber. However, as the mesh size is generally around 200 μm, passage of microemboli is possible 10,11 . The clinical sequelae associated with their passage into the circulation has not received study.…”

Section: Introductionmentioning

confidence: 99%

The extracorporeal circuit: Materials, problems, and solutions

Hoenich

2007

Hemodialysis International

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The extracorporeal circuit in hemodialysis and related therapies facilitates passage of blood to and from the patient and forms an integral link with the safety systems of the proportioning system. Historically, elements of the circuit were subject to problems such as spallation introduced by the blood pump and plasticizer from the tubing sets leaching into the blood. Many of these early issues have been largely resolved, although there is still potential for further improvement and innovation. The introduction of such improvements and innovations into clinical practice is critically dependent upon their cost and benefit to patient and renal unit staff.

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“…There have been several cases which report the presence of air emboli or microbubbles within the extracorporeal circuit (1)(2)(3)(4)(5)(6). All hemodialysis circuits contain an air trap on the venous side to measure venous pressures and to prevent large air bubbles from entering the patient.…”

mentioning

confidence: 99%

Pulsatility Produced by the Hemodialysis Roller Pump as Measured by Doppler Ultrasound

et al. 2015

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Microbubbles have previously been detected in the hemodialysis extracorporeal circuit and can enter the blood vessel leading to potential complications. A potential source of these microbubbles is highly pulsatile flow resulting in cavitation. This study quantified the pulsatility produced by the roller pump throughout the extracorporeal circuit. A Sonosite S-series ultrasound probe (FUJIFILM Sonosite Inc., Tokyo, Japan) was used on a single patient during normal hemodialysis treatment. The Doppler waveform showed highly pulsatile flow throughout the circuit with the greatest pulse occurring after the pump itself. The velocity pulse after the pump ranged from 57.6 ± 1.74 cm/s to -72 ± 4.13 cm/s. Flow reversal occurred when contact between the forward roller and tubing ended. The amplitude of the pulse was reduced from 129.6 cm/s to 16.25 cm/s and 6.87 cm/s following the dialyzer and venous air trap. This resulted in almost nonpulsatile, continuous flow returning to the patient through the venous needle. These results indicate that the roller pump may be a source of microbubble formation from cavitation due to the highly pulsatile blood flow. The venous air trap was identified as the most effective mechanism in reducing the pulsatility. The inclusion of multiple rollers is also recommended to offer an effective solution in dampening the pulse produced by the pump.

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Ultrasound detection of microembolic signals in hemodialysis accesses

Cited by 26 publications

References 12 publications

The Sensor in the Venous Chamber Does Not Prevent Passage of Air Bubbles During Hemodialysis

The Sensor in the Venous Chamber Does Not Prevent Passage of Air Bubbles During Hemodialysis

The extracorporeal circuit: Materials, problems, and solutions

Pulsatility Produced by the Hemodialysis Roller Pump as Measured by Doppler Ultrasound

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