Jonsson Per, Stegmayr Bernd Georg
Department Public Health and Clinical Medicine, Unit Medicine, Umea University, Umea, Sweden.
Int J Artif Organs. 2025 May;48(5):310-317. doi: 10.1177/03913988251334953. Epub 2025 May 4.
Microbubbles (MBs) of air occur in the hemodialysis (HD) extracorporeal circuit and may enter the bloodlines of the patient. The aim of the present study was to investigate possible sites of contamination. Seventeen patients performed 20 HD (Baxter AK200S = 5 and Artis = 15) and 930 ultrasound measurements of MBs/min (Hatteland CMD10 device). Detection ranges were diameters between 2.5 and 50 µm. Hemodiafiltration with postdilution (HDF-post) was performed in 14 dialyses, predilution (HDF-pre) in 1 dialysis, and HD using hemocontrol (HDhc) in 5 dialyses. Measurement points were M1-after the blood access, M2-before the dialyzer, M3-after the dialyzer, and M4-after the venous chamber. At each point, 10 measures of MBs were performed. MB contamination of the blood was larger at all points when the access was an arteriovenous fistula compared to a central dialysis catheter ( < 0.001). MB levels with the AK200 versus the Artis were lower at M1, higher at M2 ( ⩽ 0.005), and were similar at M3 and M4. HDF-pre had fewer MBs than HDF-post, whereas HDhc had more MBs than HDF-post ( < 0.001). An increase of MBs was seen at M2 during an internal "Autotest." No air alarms were induced during dialyses. MBs were detected in the extra corporeal circuit at all points investigated. The venous chambers used did not significantly reduce contamination. The detected MBs did not induce air alarms when the blood returned to the patient.
空气微泡（MBs）出现在血液透析（HD）体外循环中，并可能进入患者的血管。本研究的目的是调查可能的污染部位。17名患者进行了20次血液透析（百特AK200S = 5次，艺康 = 15次），并使用Hatteland CMD10设备以每分钟930次的频率对微泡进行超声测量。检测范围为直径2.5至50微米。14次透析采用后稀释血液滤过（HDF-post），1次透析采用前稀释血液滤过（HDF-pre），5次透析采用血液控制血液透析（HDhc）。测量点分别为M1-血液通路后、M2-透析器前、M3-透析器后以及M4-静脉腔后。在每个点进行10次微泡测量。与中心透析导管相比，当通路为动静脉内瘘时，血液在所有点的微泡污染都更大（<0.001）。AK200与艺康相比，M1处的微泡水平较低，M2处较高（⩽0.005），M3和M4处相似。HDF-pre的微泡比HDF-post少，而HDhc的微泡比HDF-post多（<0.001）。在内部“自动测试”期间，M2处的微泡有所增加。透析过程中未引发空气警报。在所研究的所有点的体外循环中均检测到微泡。所使用的静脉腔并未显著减少污染。当血液回流至患者时，检测到的微泡未引发空气警报。
