Nephrology Department of Henry Ford Health, Detroit, Michigan.
Vasc-Alert LLC, Lafayette, Indiana.
Kidney360. 2023 Apr 1;4(4):e476-e485. doi: 10.34067/KID.0000000000000093. Epub 2023 Mar 24.
Hemodialysis machine pressure alarms may not detect venous needle dislodgment when patients have changes in venous pressure. A cross-sectional analysis of hemodialysis treatment data identified the occurrences of venous pressure changes that would make it hard to trigger a machine alarm. A proof-of-concept use of a data analytic–derived algorithm for the detection of venous needle dislodgments was demonstrated.
: In rare instances, hemodialysis venous needles may become dislodged, and when left undetected, this can lead to severe injury or death. Although dialysis machines have alarms to detect venous needle dislodgment (VND), their range of detection is limited. An understanding of the clinical conditions that may lead to missed needle dislodgments is needed for the development of more robust detection systems.
: We created a sham dialysis circuit with a Fresenius 2008K dialysis machine for simulation testing of machine alarm behavior under variable conditions. The circuit used a blood substitute and mimicked a patient's venous access site. We varied blood flow rate, venous pressure (VP), and upward drift in VP and analyzed the time to alarm for the machine and an improved alarm algorithm. We also performed a cross-sectional retrospective study to identify the clinical occurrence of VP upward drift between September 1, 2016, and November 1, 2016, in patients on hemodialysis with an arteriovenous fistula.
: Of 43,390 VP readings for 147 patients on hemodialysis, 16,594 (38%) showed an upward drift in VP (range 20–79 mmHg), with a mean±SD increase of 11±18 mm Hg within 20±14 minutes. A total of 19 VND simulations under different VP and blood flow parameters resulted in 19 (100%) algorithm alarm activations. Only eight simulations (42%) activated a machine alarm, and machine alarm activation time was longer than the algorithm activation time for all eight machine alarms (range 1–13 seconds).
: Patients can experience changes in VP during hemodialysis which may not trigger a machine alarm in the case of a VND. Our simulations showed that current dialysis machine alarm systems may not compensate for upward drift in VP, and improved algorithms for detecting needle dislodgment during hemodialysis are needed.
当患者静脉压发生变化时，血液透析机会的压力警报可能无法检测到静脉内针头脱出。对血液透析治疗数据的横断面分析确定了会使机器警报难以触发的静脉压变化的发生。演示了一种用于检测静脉内针头脱出的基于数据分析的算法的概念验证用途。
在极少数情况下，血液透析静脉内针头可能会脱出，并且如果未被发现，这可能会导致严重伤害或死亡。尽管透析机具有用于检测静脉内针头脱出（VND）的警报，但它们的检测范围有限。需要了解可能导致针头脱出的临床情况，以便开发更强大的检测系统。
我们使用 Fresenius 2008K 透析机为模拟测试创建了一个假的透析回路，以在不同条件下模拟机器警报行为。该回路使用血液替代品并模拟了患者的静脉接入部位。我们改变了血流速度、静脉压（VP）、VP 的向上漂移，并分析了机器和改进的警报算法的警报时间。我们还进行了一项横断面回顾性研究，以确定 2016 年 9 月 1 日至 2016 年 11 月 1 日期间接受动静脉瘘血液透析的患者的 VP 向上漂移的临床发生情况。
在接受血液透析的 147 名患者的 43,390 个 VP 读数中，有 16,594 个（38％）VP 显示向上漂移（范围为 20-79mmHg），在 20±14 分钟内平均增加 11±18mmHg。在不同的 VP 和血流参数下进行了 19 次 VND 模拟，导致 19 次（100％）算法警报激活。只有 8 次模拟（42％）激活了机器警报，并且对于所有 8 次机器警报，机器警报激活时间都长于算法激活时间（范围为 1-13 秒）。
患者在血液透析过程中可能会经历 VP 的变化，在发生 VND 的情况下，这可能不会触发机器警报。我们的模拟表明，当前的透析机警报系统可能无法补偿 VP 的向上漂移，并且需要用于检测血液透析过程中针头脱出的改进算法。
