Air contamination during hemodialysis should be minimized

Area of Science:

• Nephrology
• Biomedical Engineering
• Cardiovascular Science

Background:

• Hemodialysis (HD) extracorporeal circuits (ECC) require priming to remove air.
• Micro embolic signals (MES), potentially from clots or gas emboli, are detected in the ECC using ultrasound techniques.
• These emboli can originate within the ECC and bypass safety features like air traps.

Purpose of the Study:

• To review the development of micro embolic signals (MES) during hemodialysis (HD).
• To discuss measures for limiting patient exposure to MES in the extracorporeal circuit (ECC).

Main Methods:

• Review of in vitro studies on emboli development within the ECC.
• Analysis of clinical studies confirming MES presence and passage during conventional HD.
• Examination of autopsy findings of gas emboli in patient tissues.

Main Results:

• In vitro studies demonstrate air emboli formation within the ECC, bypassing safety systems.
• Clinical studies confirm MES passage into the venous line during HD without alarms.
• MES have been detected in the AV fistula, subclavian vein, and carotid artery.
• Autopsies reveal gas emboli with clots in lung, brain, and myocardial tissue.

Conclusions:

• Micro embolic signals (MES) pose a risk during hemodialysis (HD) due to their ability to bypass safety mechanisms.
• Understanding the development of these emboli is crucial for patient safety.
• Further research into mitigation strategies is needed to limit exposure during HD procedures.