Nephrol Dial Transplant (2000) 15: 1420-1424
© 2000 European Renal Association-European Dialysis and Transplant Association
Identification of microemboli during haemodialysis using Doppler ultrasound
1 Departments of Cardiovascular Surgery of Limoges University Hospital, Limoges, 2 Ultrasound and Nuclear Medicine, and 3 Chronic Hemodialysis of Tours University Hospital, Tours, France
Background. Doppler ultrasound methods were used during haemodialysis sessions for the detection of microemboli and determination of their origin.
Methods. A 2-MHz ultrasound probe (Multidop X4 DWLTM) was used to assess the number of microembolic signals (MES) in the subclavian vein downstream from the arteriovenous fistula before the dialysis session and over two periods of 15 min at the beginning and end of haemodialysis sessions in 25 patients without previous cardiovascular disease. A similar probe was used during in vitro studies to detect MES at different sites in the dialysis machine (before and downstream from the blood pump, and before and downstream from the air trap).
Results. No MES were detected during in vivo studies before haemodialysis sessions. MES were registered in all patients (100%) at the beginning and end of the haemodialysis procedure at an average of 12.7±9 and 16.7±11.5 signals/min respectively. The average intensity of MES was 19.2±5.0 dB and 19.4±3.9 dB respectively. No MES were detected on the arterial line during in vitro studies. In contrast, 19±6 MES/min were detected after the blood pump, 13±4.2 before the air trap, and 16.5±5.5 thereafter.
Conclusions. In all patients, MES were recorded during haemodialysis sessions in the drainage vein from arteriovenous fistulae. The results of in vitro studies indicate that MES are formed by the blood pump of the haemodialysis machine. The intensity of the MES suggests that they correspond to synthetic particles or microbubbles, which are not detected by the air trap. The final destination of these microbubbles will be assessed in further studies.
Keywords: Doppler ultrasound; haemodialysis; microembolic signals; roller pump
Correspondence and offprint requests to: Dr François Tranquart, INSERM U316, CHU Bretonneau, F-37044 Tours Cedex 1, France.
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