Wagner S, Rode C, Wojke R, Canaud B. Observation of microbubbles during standard dialysis treatments.
Clin Kidney J 2015;
8:400-4. [PMID:
26251706 PMCID:
PMC4515906 DOI:
10.1093/ckj/sfv051]
[Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 06/05/2015] [Indexed: 11/14/2022] Open
Abstract
Background
The 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.
Methods
Microbubbles 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).
Results
Several 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).
Conclusions
Microbubbles 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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