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BACKGROUND The dialysis bath holds up to 90 mmHg carbon dioxide (CO2 ) in order to keep pH low and salts in their soluble forms. CO2 crosses the dialyzer membrane and diffuses to patients. In post-dilution on-line hemodiafiltration (HDF) many liters of CO2 -containing dialysis bath - in the form of infusate - are delivered directly to patients bypassing the filtering membrane, but the precise amount of CO2 delivered is unknown. METHODS To gain insights on this issue 18 outpatients undergoing their regular on-line HDF were investigated by means of blood gas analysis. RESULTS Arterial pre-dialysis samples show slight hypocapnia (35.40 ± 3.22 mmHg) consistent with the secondary compensatory response to metabolic acidosis. In blood coming back to patients (venous line of extracorporeal circuit) pCO2 doubled, amounting to 69 ± 5.5 mmHg (P

The objective of this study was to compare the hemodynamic performances and gaseous microemboli (GME) handling ability of two pediatric oxygenators in a simulated pediatric cardiopulmonary bypass (CPB) model and the importance of adding an arterial filter in the circuit. The circuit consisted of a Braile Infant oxygenator or a Maquet Quadrox-I Pediatric oxygenator without integrated arterial filter (parallel arrangement), 1/4 in. ID tubing A-V loop, and a 12-Fr arterial cannula, primed with lactated Ringer's solution and packed red blood cells. Trials were conducted at flow rates ranging from 500 to 2000 mL/min (500 mL/min increment) at 35°C and 28°C. Real-time pressure and flow data were recorded using a custom-based data acquisition system. For GME testing, 5 cc of air was manually injected into the venous line. GME were recorded using the Emboli Detection and Classification Quantifier (EDAC) System. An additional experiment using a separate arterial filter was conducted. There was no difference in the mean circuit pressure, pressure drop, total hemodynamic energy level, and energy loss between the two oxygenators. The venous line pressures were higher in the Braile than in the Quadrox group during all trials (P

Study Objective: The objective of the study is to compare the anti-factor Xa (AXa) level in the blood, after arterial and venous line administration of equivalent doses of enoxaparin for prevention of thrombosis in the extracorporeal blood circuit.Design: The design of the study is a dual centre, prospective, open-labelled randomized crossover, 7 weeks trial.Setting: The setting of the study is on a patient on long-term haemodialysis (HD) or haemodiafiltration (HDF) using high-flux membrane.Participant: There were eight patients on HD and eight on HDF.Intervention: Participants were randomly assigned to receive enoxaparin either through the arterial line or venous line of extracorporeal blood circuit for an initial study interval of 2 weeks, followed by 2 weeks of alternate route administration. During the run-in period of 1 week and the follow-up period of 2 weeks, enoxaparin was administered through the arterial line.Outcomes: The primary outcome measure was to compare AXa blood level 4 h after enoxaparin administration. The secondary outcome measures were manual compression time to stop bleeding from arteriovenous fistula, extracorporeal circuit clotting and systemic bleeding episodes.Results: The mean AXa blood level, 4 h after venous circuit administration (0.58 +/- 0.21 (HD), 0.82 +/- 0.29 (HDF)) of enoxaparin, was significantly greater than that after arterial administration of enoxaparin (0.39 +/- 0.25 (HD), 0.39 +/- 0.14 (HDF) U/mL), (P

Venous air embolism was suspected in 3 hospitalised horses on the basis of an inadvertently open jugular venous line. Subsequently the 3 horses developed clinical signs including cardiovascular collapse, cardiac dysrhythmia, pulmonary oedema, behavioural abnormalities and neurological signs consistent with central nervous system injury. Treatment included intranasal oxygen therapy, i.v. fluid administration and anti-inflammatory therapy. Specific therapy aimed at treating air embolism in man is reviewed, with pertinent therapy potentially applicable to horses emphasised.

Minimized perfusion circuits (MPCs) have been criticized for insufficient air elimination. The deairing capabilities of a new MPC, including an ultrasound controlled deairing unit, were compared to a standard extracorporeal circuit (ECC) in a laboratory setup. During blood flow of 4.0l/min, we injected 30-cc air over a period of 30 s into the venous line of both systems (n = 10 measurements/15-min intervals). Air was detected during the first 2 min post injection using a dual-channel ultrasound bubble counter. Venous air bubble measurements were made after the MPC bubble trap and the ECC hard-shell reservoir, respectively. Arterial air bubble data were obtained after the arterial filters (40 microm). Venous bubble count was significantly (P0.01) reduced in the MPC group (5-250 microm, 681 +/- 177;40 microm, 288 +/- 92) compared with the ECC group (5-250 microm, 19 272 +/- 682;40 microm, 7642 +/- 520). After the arterial filter, minimal numbers of air bubbles (5-250 microm, 172 +/- 59;40 microm, 0) could be detected in the MPC group, but large amounts of air (5-250 microm, 16 194 +/- 1072;40 microm, 3732 +/- 997) were measured in the ECC group. The air elimination of the modern MPC is superior to conventional ECC, which may result in a reduction of neurological complications.

Background: LMWH ensures circuit permeability in hemodialysis but can lead to systemic bleeding for patients with hemorrhagic risk. Other anticoagulation alternatives are laborious and cumbersome with BHD. Regional citrate anticoagulation can be simplified with DCB, a new hemodialysis method using a dialysate containing only sodium chloride and bicarbonate. The optimal amount of ionic complement (Ca++, Mg++, K+) is automatically perfused into venous line according to the value of ionic dialysance measured every 15 minutes by the Integra dialysis monitor (Hospal, Italy). Methods: Thirty DCB-citrate sessions were performed in 10 patients at increased risk of bleeding. After resolution of bleeding risk, the same number of BHD sessions was performed in patients. The aim of this study is to compare pressure time of the arterio-venous access (PT), index thrombosis circuit (ITC 0:clean to 5:total thrombosis), Kt/V and biochemical data at the end of sessions (mean ± SD). DCB-citrate (n = 21) BHD-LMWH (n = 21) p PT (min) 4 ± 1.1 9 ± 4.6

The use of total nutrient admixtures (TNA) has increased dramatically in both the clinical and home care setting since 1983. The popularity of these dosage forms rests in supplying all the nutrients in one container that meets the nutritional goals of the patient. In addition, TNA formulations obviate the need for either separate peripheral venous catheters or co-infusions into the primary venous line, thus simplifying this complex therapy. Moreover, the clinical benefits derived from this practice are related to a reduction in glucose-associated complications that assume particular importance in the acutely ill patient. Although much experience has been gained over the last 12 years, practice standards vary with the institution. Despite this, TNA therapy has been successful in the U.S. This paper attempts to delineate the important physicochemical variables that influence emulsion stability as they relate to clinical practice.

Venous line disconnection or needle dislodgement during hemodialysis with resultant hemorrhage is a potentially lethal event. The risk is compounded by the frequent failure of standard dialysis machines to detect the event, as blood flow through the venous needle typically creates enough back pressure to prevent venous pressure alarms even if the needle is completely out of the patient's AV access. Manufacturers are well aware of the risk and device literature contains specific warnings about it. The FDA publishes reports on its website about these events; so far this year there have been seven reported events with five deaths. Informal sources indicate that the actual (unreported) occurrence is much more frequent; we are aware of four additional events within our region alone. Efforts to reduce the risk include protocols requiring the access needles to always be visible, and use of enuresis detection devices. Anecdotal experience with these efforts suggests they are not highly effective. Protocols requiring documentation of more frequent needle site checks or alternate methods of securing the needles have not been formally evaluated. However, such efforts do not address the primary problem: there is a need for an engineered solution to this problem. Requirements for such a solution include: reliable detection of needle position and blood flow discrepancies, a useful alarm, and feedback to stop the blood pump. Persistence of this problem raises issues of regulatory oversight.

Plasma exchange was performed on a patient with hemophilia A and inhibitor to factor VIIIC prior to bilateral cataract removal. Koate was used as replacement fluid with effective reduction of the inhibitor level. From the technical standpoint we found out that factor VIII is best reconstituted in water and directly infused through the venous line and not the centrifuge bowl.