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ID 110961
Title Alternative
至適透析や溶血回避のための血液ポンプ前の動脈圧の再評価 : 血液透析患者における血液ポンプ前の動脈圧モニタリングの重要性
Importance of pre pump arterial pres sure monitoring in hemodialysis patients
Author
Takeuchi, Risa The University of Tokushima
Noda, Yasuhiro The University of Tokushima
Makino, Tomomi The University of Tokushima
Chikata, Yusuke The University of Tokushima
Hann, Michael Naval Medical Center San Diego
Yoshimoto, Sakiya The University of Tokushima
Ono, Hiroyuki The University of Tokushima
Ueda, Sayo The University of Tokushima
Murakami, Taichi The University of Tokushima KAKEN Search Researchers
Matsuura, Motokazu The University of Tokushima KAKEN Search Researchers
Keywords
Prepump arterial pressure
Hemolysis
pressure pillow
Dialysis
Blood flow
Vacuum monitor
Content Type
Thesis or Dissertation
Description
Pre-pump arterial pressure (PreAP) is monitored to avoid generating excessive negative pressure. National Kidney Foundation K/DOQI clinical practice guidelines for vascular access recommend that PreAP should not fall below-250 mmHg 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 mmHg 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 mmHg. 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.
Journal Title
Artificial Organs
ISSN
0160564X
15251594
NCID
AA00551950
AA11616446
Publisher
International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.
Volume
39
Issue
7
Start Page
627
End Page
634
Published Date
2015-05-01
Remark
内容要旨・審査要旨・論文本文の公開
本論文は, 著者Eriko Shibataの学位論文として提出され, 学位審査・授与の対象となっている。
EDB ID
DOI (Published Version)
URL ( Publisher's Version )
FullText File
language
eng
TextVersion
ETD
MEXT report number
甲第3117号
Diploma Number
甲医第1352号
Granted Date
2017-10-26
Degree Name
Doctor of Medical Science
Grantor
Tokushima University
departments
Medical Sciences
University Hospital