Dellanna F, Stippel D, Schmitz W, Baldamus CA
Safety of hemodialysis machines: Surveillance of the venous
blood return
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Nov) 6:486 1995
The purpose of the lower venous pressure alarm is to protect
against continued blood flow in the event of accidental
disconnection. Some machines keep this limit close to the
operating venous pressure throughout dialysis, whereas with other
machines, the limit can be set manually, usually 20-50 mm Hg on
either side of the operating pressure. As the venous pressure
tends to fluctuate, it is difficult to manually keep the pressure
limits very close to the operating pressure.
Dellanna et al report 3 patients in whom the venous needle worked
its way out of the fistula without triggering the venous pressure
alarm, and without stopping the blood pump. They then did some
simulation studies and found that the venous pressure fell by
only about 20 mm Hg when the venous needle was pulled out of the
fistula, most of the resistance being in the needle itself. The
data suggest that the lower venous pressure limit should track
the operating venous pressure closely, and should be within 10-20
mm Hg of the operating pressure if the alarm is to be activated
in a disconnect situation.
(Daugirdas)
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