Re-evaluation of Pre-pump Arterial Pressure to Avoid Inadequate Dialysis and Hemolysis: Importance of Prepump Arterial Pressure Monitoring in Hemodialysis Patients.
Prepump arterial pressure (PreAP) is monitored to avoid generating excessive negative pressure. The National Kidney Foundation K/DOQI clinical practice guidelines for vascular access recommend that PreAP should not fall below -250 mm Hg because excessive negative PreAP can lead to a decrease in the delivery of blood flow, inadequate dialysis, and hemolysis. Nonetheless, these recommendations are consistently disregarded in clinical practice and pressure sensors are often removed from the dialysis circuit. Thus far, delivered blood flow has been reported to decrease at values more negative than -150 mm Hg of PreAP. These values have been analyzed by an ultrasonic flowmeter and not directly measured. Furthermore, no known group has evaluated whether PreAP-induced hemolysis occurs at a particular threshold. Therefore, the aim of this study was to clarify the importance of PreAP in the prediction of inadequate dialysis and hemolysis. By using different diameter needles, human blood samples from healthy volunteers were circulated in a closed dialysis circuit. The relationship between PreAP and delivered blood flow or PreAP and hemolysis was investigated. We also investigated the optimal value for PreAP using several empirical monitoring methods, such as a pressure pillow. Our investigation indicated that PreAP is a critical factor in the determination of delivered blood flow and hemolysis, both of which occured at pressure values more negative than -150 mm Hg. With the exception of direct pressure monitoring, commonly used monitoring methods for PreAP were determined to be ineffective. We propose that the use of a vacuum monitor would permit regular measurement of PreAP.
Department of Nephrology, Graduate School of Medicine, Health-Bioscience Institute, The University of Tokushima, Tokushima, Japan.
Eriko
E
Shibata
Department of Nephrology, Graduate School of Medicine, Health-Bioscience Institute, The University of Tokushima, Tokushima, Japan.
Kojiro
K
Nagai
Department of Hemodialysis, Graduate School of Medicine, Health-Bioscience Institute, The University of Tokushima, Tokushima, Japan.
Risa
R
Takeuchi
Department of Hemodialysis, Graduate School of Medicine, Health-Bioscience Institute, The University of Tokushima, Tokushima, Japan.
Yasuhiro
Y
Noda
Department of Hemodialysis, Graduate School of Medicine, Health-Bioscience Institute, The University of Tokushima, Tokushima, Japan.
Tomomi
T
Makino
Department of Emergency and Critical Care, Graduate School of Medicine, Health-Bioscience Institute, The University of Tokushima, Tokushima, Japan.
Yusuke
Y
Chikata
Department of Graduate Medical Education, Naval Medical Center San Diego, San Diego, CA, USA.
Michael
M
Hann
Department of Nephrology, Graduate School of Medicine, Health-Bioscience Institute, The University of Tokushima, Tokushima, Japan.
Sakiya
S
Yoshimoto
Department of Nephrology, Graduate School of Medicine, Health-Bioscience Institute, The University of Tokushima, Tokushima, Japan.
Hiroyuki
H
Ono
Department of Nephrology, Graduate School of Medicine, Health-Bioscience Institute, The University of Tokushima, Tokushima, Japan.
Sayo
S
Ueda
Department of Nephrology, Graduate School of Medicine, Health-Bioscience Institute, The University of Tokushima, Tokushima, Japan.
Masanori
M
Tamaki
Department of Nephrology, Graduate School of Medicine, Health-Bioscience Institute, The University of Tokushima, Tokushima, Japan.
Taichi
T
Murakami
Department of Nephrology, Graduate School of Medicine, Health-Bioscience Institute, The University of Tokushima, Tokushima, Japan.
Motokazu
M
Matsuura
Department of Nephrology, Graduate School of Medicine, Health-Bioscience Institute, The University of Tokushima, Tokushima, Japan.
Hideharu
H
Abe
Department of Nephrology, Graduate School of Medicine, Health-Bioscience Institute, The University of Tokushima, Tokushima, Japan.
Toshio
T
Doi
D000328:Adult; D000368:Aged; D062186:Arterial Pressure; D001783:Blood Flow Velocity; D005260:Female; D006461:Hemolysis; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods
Blood flow; Dialysis; Hemolysis; Prepump arterial pressure; Pressure pillow; Vacuum monitor