Nephrology Dialysis Transplantation, Vol 13, Issue 8 2098-2103, Copyright © 1998 by Oxford University Press
C Johner, P Chamney, D Schneditz and M Kramer
Background. Hypotension complicates approximately 30%
of all dialysis treatments. Although the genesis of hypotension is
multifactorial, hypovolaemia is thought to play a major role as a direct
result of decreased blood volume, particularly during ultrafiltration. The
described blood volume monitor enables blood volume to be measured
continuously by a non-invasive technique. Methods. The
blood volume monitor is based on the principle that the total protein
concentration, the sum of haemoglobin and plasma proteins in the vascular
space, changes during ultrafiltration. Changes of total protein
concentration are determined from the velocity of sound waves in blood,
measured using a cuvette in the extracorporeal circuit designed for this
purpose. The precision of the blood volume monitor was evaluated in 180
dialysis treatments in 49 patients. The relative blood volume obtained by
the monitor was compared with a standard reference method involving
calculation of relative blood volume from serial measurements of
haemoglobin. Results. A very good agreement between
the two methods was achieved (SD = 1.70%, r
>0.96). The results showed no sensitivity to changes in serum sodium
concentration (range 130-145 mmol). The 'noise' introduced in the blood
volume signal was low (⩽0.2%, sampling rate 10 s) allowing subtle
blood volume changes to be detected with high resolution. In addition the
device enabled the measurement of haematocrit (Hct) and haemoglobin (Hb) to
be made since this is the largest blood component determining total protein
concentration. A comparison with the centrifuge method revealed an accuracy
of ± 2.9Hct-%, and a comparison with the photometer an accuracy
of ±0.8g Hb/dl. Conclusion. In summary the
blood volume monitor allows precise and reliable measurement of relative
blood volume. It provides the instrumentation essential for feedback
control of relative blood volume during dialysis.
Keywords: blood volume, haemodialysis; haemoglobin;
instrumentation; ultrafiltration; ultrasound
TECHNICAL REPORT
Evaluation of an ultrasonic blood volume monitor
Fresenius Medical Care, Innovation and Technology, Bad Homburg, Germany; Lister Hospital, Stevenage, UK; Beth Israel Medical Center, New York, NY, USA; Correspondence to: C Johner, Fresenius Medical Care, Innovation and Technology, Daimlerstrasse 15, D-61352 Bad Homburg, Germany
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