Identification of microemboli during haemodialysis using Doppler ultrasound

Rolle, F.; Pengloan, J; Abazza, Mohamed; Halimi, Jean Michel; M, Laskar; Pourcelot, L.; Tranquart, F.

doi:10.1093/ndt/15.9.1420

Cited by 38 publications

(30 citation statements)

References 19 publications

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“…Microemboli (platelet aggregates or gaseous microbubbles) have been identified in the arteriovenous fistulae of HD patients [9]. Because a PFO allows paradoxical embolisation, patients undergoing HD could theoretically suffer microembolisation to organs including the brain.…”

Section: Introductionmentioning

confidence: 99%

Does a Patent Foramen Ovale Influence Cognitive Function in Dialysis Patients?

George¹,

Holt

Medford

et al. 2013

Nephron Clin Pract

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Background: Patients with chronic kidney disease on dialysis treatment have poorer cognitive function than age- and sex-matched controls. One proposed mechanism is cerebral microembolisation due to material from the dialysis circuit crossing a patent foramen ovale (PFO). Methods: Cognitive testing was carried out in haemodialysis (HD) patients and peritoneal dialysis (PD) patients. Transthoracic echocardiography was used to identify PFO. Follow-up testing 1 year later enabled comparison of cognitive decline between patients with and without a PFO, and between those undergoing different dialysis modalities. Results: 80 patients (aged 60.4 ± 15.0 years) were recruited (51 HD patients and 29 PD controls). A PFO was found in 21% of patients. 83% of dialysis patients suffered a decline in one or more cognitive function tests over 1 year. There was a significant difference in only one test between HD patients with or without a PFO. PD patients showed a more rapid cognitive decline than those on HD. Conclusions: Cognitive decline in dialysis patients is rapid and affects most patients. The presence of a PFO made only subtle differences to the rates of cognitive decline during 1 year of follow-up. Patients with a PFO should not be prevented from considering HD because of concerns of cerebral decline due to microembolisation.

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Section: Introductionmentioning

confidence: 99%

Does a Patent Foramen Ovale Influence Cognitive Function in Dialysis Patients?

George¹,

Holt

Medford

et al. 2013

Nephron Clin Pract

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show abstract

“…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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Identification of microemboli during haemodialysis using Doppler ultrasound

Cited by 38 publications

References 19 publications

Does a Patent Foramen Ovale Influence Cognitive Function in Dialysis Patients?

Does a Patent Foramen Ovale Influence Cognitive Function in Dialysis Patients?

The extracorporeal circuit: Materials, problems, and solutions

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

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