In vitro testing of prevailing materials and initial clinical findings

• Objectives: During HD previous studies have shown that especially micro bubbles of air may pass the air detector. These studies focused to analyse in vitro if the air trap of various producers may contribute to the presence of micro embolic counts in the fluid that has passed the air trap detector. In addition another in vitro study analysed if the dialyzer by itself may contribute to these contaminations. In parallel a clinical study was performed to evaluate if findings during in vitro tests could be found to some extent during chronic hemodialysis. If such contamination was present how frequent this would be and would it be a greater risk at the start or the end of dialysis. Methods: A ultrasound probe was placed on the venous dialysis tube after the air detector and venous chamber (Hatteland, Norway). Results:The studies verified previous in vitro studies with micro embolic counts that pass the air trap without inducing an alarm. Fewer embolic signals were detected in the in vitro studies when using a high level of the fluid in the air trap and when using a wet dialyzers. In the clinical studies high counts were present both at the first period as well as the last period of hemodialysis. Conclusions: These studies verify the finding of embolic counts in various extents in various in vitro settings, but also verify the presence of such counts in the dialysis tubes after the air trap in clinical routine hemodialysis. Further studies are warranted to clarify how to prevent patients from such problems and to clarify if the counts are clinically relevant.

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