Two‐Dimensional Computational Analysis of Microbubbles in Hemodialysis

Keshavarzi, Gholamreza; Barber, Tracie; Yeoh, Guan Heng; Simmons, Anne; Reizes, John

doi:10.1111/aor.12110

Cited by 14 publications

(13 citation statements)

References 16 publications

(37 reference statements)

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“…Most microbubbles ,50 mm in diameter and many microbubbles between 50 and 200 mm pass through the venous bubble catcher without triggering an alarm (33). The rate of microbubble formation is dependent on the blood flow rate and negative arterial pressure.…”

Section: Air Embolismmentioning

confidence: 99%

Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies

Saha

Allon

2016

CJASN

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Given the high comorbidity in patients on hemodialysis and the complexity of the dialysis treatment, it is remarkable how rarely a life-threatening complication occurs during dialysis. The low rate of dialysis emergencies can be attributed to numerous safety features in modern dialysis machines; meticulous treatment and testing of the dialysate solution to prevent exposure to trace elements, toxins, and pathogens; adherence to detailed treatment protocols; and extensive training of dialysis staff to handle medical emergencies. Most hemodialysis emergencies can be attributed to human error. A smaller number are due to rare idiosyncratic reactions. In this review, we highlight major emergencies that may occur during hemodialysis treatments, describe their pathogenesis, offer measures to minimize them, and provide specific interventions to prevent catastrophic consequences on the rare occasions when such emergencies arise. These emergencies include dialysis disequilibrium syndrome, venous air embolism, hemolysis, venous needle dislodgement, vascular access hemorrhage, major allergic reactions to the dialyzer or treatment medications, and disruption or contamination of the dialysis water system. Finally, we describe root cause analysis after a dialysis emergency has occurred to prevent a future recurrence.

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Section: Air Embolismmentioning

confidence: 99%

Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies

Saha

Allon

2016

CJASN

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“…First, as already demonstrated [ 6 , 7 , 12 – 14 ], microbubbles may pass the safety system against air infusion without triggering an alarm.…”

Section: Discussionmentioning

confidence: 91%

“…Air might be dragged below the blood level, and at low blood levels, the buoyant force might not be sufficient to separate small bubbles from downwards flowing blood. Then, small bubbles may be injected into the patient [ 6 , 7 , 12 – 14 ].…”

Section: Discussionmentioning

confidence: 99%

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Observation of microbubbles during standard dialysis treatments

Wagner¹,

Rode²,

Wojke

et al. 2015

Clin Kidney J

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BackgroundThe infusion of microbubbles as a side effect of haemodialysis was repeatedly demonstrated in recent publications, but the knowledge on the source of microbubbles and on microbubble formation is scarce.MethodsMicrobubbles in the range of 10–500 µm were measured by a non-invasive bubble counter based on a pulsed ultrasonic Doppler system in a non-interventional study of a single centre. Totally, 29 measurements were performed in standard treatments covering a broad range of patient and treatment conditions (types of blood access, treatment modes, blood flow rates and arterial pressures).ResultsSeveral possible sources of microbubbles could be identified such as an arterial luer lock connector at negative pressure and remnant bubbles from insufficient priming, but some sources of microbubbles remain unknown. Microbubbles were found in all treatments, haemodialysis (HD) and online haemodiafiltration. The lowest average microbubble rates (17 ± 16 microbubbles per minute) were observed in patients treated by online haemodiafiltration at medium blood flow rates and moderate arterial pressures and the highest average microbubble rates (117 ± 63 microbubbles per minute) at high blood flow rates (550 mL/min) and low arterial pressures (−210 mmHg). Generally, the microbubble rate correlated to both blood flow rate (correlation coefficient r = 0.45) and negative arterial pressure (r = 0.67).ConclusionsMicrobubbles are a general side effect of HD; origin and pathophysiologic consequences of this phenomenon are not well understood, and deserve further study.

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“…Microbubbles in the range of 5-42.5 μm have been shown to pass through the venous air trap without activating the alarm and enter the blood stream (1,2,5,7). In addition, preliminary computational simulations have shown the inefficiency of the venous air trap in trapping bubbles smaller than 200 μm (7). It is important to identify the source of microbubble formation in hemodialysis as there are potential pathophysiological complications for the patient.…”

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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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Two‐Dimensional Computational Analysis of Microbubbles in Hemodialysis

Cited by 14 publications

References 16 publications

Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies

Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies

Observation of microbubbles during standard dialysis treatments

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

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