Venous chambers in clinical use for hemodialysis have limited capacity to eliminate microbubbles from entering the return bloodline: An in vitro study

Abstract

AbstractBackgroundDuring hemodialysis (HD), blood passes through an extracorporeal circuit (ECC). To prevent air administration to the patient, a venous chamber (chamber) is located before the blood return. Microbubbles (MBs) may pass through the chamber and end up as microemboli in organs such as the brain and heart.This in vitro study investigated the efficacy of various chambers in MB removal.Materials and MethodsThe in vitro recirculated setting of an ECC included an FX10 dialyzer, a dextran‐albumin solution to mimic blood viscosity and chambers with different flow characteristics in clinical use (Baxter: AK98 and Artis, Fresenius: 5008 and 6008) and preclinical test (Embody: Emboless®). A Gampt BCC200 device measured the presence and size of MBs (20–500 μm). Percentage change of MBs was calculated: ΔMB% = 100*(outlet–inlet)/inlet for each size of MB. Blood pump speed (Qb) was 200 (Qb200) or 300 (Qb300) ml/minute. Wilcoxon paired test determined differences.ResultsWith Qb200 median ΔMB% reduction was: Emboless −58%, AK98 −24%, Fresenius 5008 −23%, Artis −8%, and Fresenius 6008 ± 0%. With Qb300 ΔMB% was: Emboless −36%, AK98 ± 0%, Fresenius 5008 ± 0%, Artis +25%, and Fresenius 6008 + 21%. The Emboless was superior to all other chambers with Qb200 and Qb300 (p < 0.001). Further, the Emboless with Qb300 still eliminated more MBs than all other chambers with Qb200 (p ≤ 0.003).ConclusionThe results from the present study indicate that flow characteristics of the chamber and the Qb are important factors to limiting exposure of MB to the return bloodline. The Emboless chamber reduced MBs more effective than those chambers in clinical use investigated.