Re-evaluation of Pre- aim of this study was to clarify the importance of PreAP in the prediction of

pump Arterial inadequate dialysis and hemolysis.

Pressure to Avoid
Inadequate Dialysis and Prepump arterial pressure (PreAP) is monitored to avoid generating excessive
Hemolysis: Importance negative pressure. PreAP should not fall below −250 mm Hg because excessive
of Prepump negative PreAP can lead to a decrease in the delivery of blood flow, inadequate
Arterial Pressure dialysis, and hemolysis.
Monitoring in
Hemodialysis Patients PreAP monitoring has also been shown to be useful in the avoidance of harmful
negative pressure which could give rise to blood damage. Blood damage is one of the
Eriko Shibata, *Kojiro primary complications in hemodialysis (HD). Any damage to red blood cells can
Nagai, †Risa decrease the cellular life span and contribute to anemia. Several factors contribute to
Takeuchi,[2015] hemolysis, including shear stresses, blood/air interface, and blood attachment to
foreign surfaces more cost-effective systems, including automatic priming and
reinfusion systems using dialysate,

Result
PreAP is an important factor that affects both delivered blood flow and hemolysis.
The threshold of PreAP that contributes to these problems was −150 mm Hg. PreAP
monitoring methods, such as pulsating movement and a pressure pillow, were not
effective in the detection of optimal PreAP

PreAP is a critical factor in the delivery of actual blood flow. Blood flow also causes
shear stress, which is one of the primary causes of hemolysis. Peripheral dialysis
needles are expected to have the highest shear stresses within a dialysis circuit.

Arterial line pressure An extracorporeal is a medical procedure which is performed outside the body
control enhanced The extracorporeal circuit provides the necessary conduit for transporting blood from
extracorporeal blood the patient's vascular system (via arteriovenous access)
flow prescription in
hemodialysis patients The pressure generated by the pump carries blood flow into the arterial segment of
the dialysis circuit (arterial line) and is measured continuously, denominated dynamic
Franklin G Mora- arterial line pressure (DALP). DALP is a negative pressure that has been used to
Bravo*†1, Alfonso determine catheter dysfunction, which is identified when a dialysis blood flow of 300
Mariscal†1, Juan P mL/min is not being attained in a catheter previously able to deliver greater Qb than
Herrera–Felix†1, 350 mL/min and at a pre pump pressure of -250 mmHg3
Salvador
Magaña†1,[2008] The instrumentation and continuous measurement of the pressures in the arterial and
venous lines allow us to know static and dynamic parameters of the internal pressure
in the access site.

Methods
Patients
 We enrolled 91 patients from our chronic hemodiafiltration (HDF) dialysis unit and
in the renal transplant program from our institute, who received 3 HDF sessions per
week (11.5 to 12 hrs/wk). Patients received anticoagulation with heparin sodium
2.000 units at the beginning of treatment and 1000 units per hour. The machines are
equipped with a pre pump measuring system for dynamic arterial line pressure,
a blood temperature monitor (BTM)

Dynamic arterial line pressure is a negative pressure generated by the machine's

peristaltic pump. The dynamic nomination must be, so that it translates the negative
pressure of the pump in movement from arterial line to vascular access. This study
describes extracorporeal blood low prescription based on DALP which permits to
optimize Qb until limits near to 500 ml/min could be attained.

In conclusion this investigation has shown that Qb prescription can be optimized by

DALP. DALP of -200 mmHg is recommended for obtaining the best Qb. Staff
adherence to DLAP treatment prescription could be reached up to 81.3% in catheters
and 84.1% in AV fistulae

How to perform a In the past few years, the extracorporeal life support (ECLS) is being used more
haemodialysis using the frequently to assist adult patients presenting acute cardiac and pulmonary
arterial and venous dysfunctions
lines of an
extracorporeal life The femoral vein is less frequently chosen, due to the septic risk, and the potential
support risk of thrombosis in the neighbourhood of the ECLS cannulae. These conclusions
Sylvain Rubin a,*, Anne lead us to imagine an ‘illogical’ but original and very simple solution to connect the
Poncet a, Alain Wynckel haemodialysis on the venous and arterial lines of the ECLS. The inflow of the
b,[2009] haemodialysis is connected to the arterial line, and the outflow is connected to the
venous line using two 3-way taps (Luer Lock).

Due to the constant low cardiac output before the ECLS implantation, the
haemodialysis is frequently required at the time of the assistance initiation

In summary, during a haemodialysis, the arterial blood is taken from the

corresponding line and re-injected by the venous line, creating a shunt due to the
recirculation of the haemodialysed blood in the ECLS. In practice, the haemodialysis
needs a stable blood flow rate between 150 ml min_1 and 180 ml min_1 and filtration
flow rates ranges from 30 ml min_1 to 40 ml min_1 to provide an adequate urea
clearance. Therefore, it can be overlooked because of the performance of the actual
ECLS (mean blood flow: 3.9 l min_1).
Surveillance and Currently arteriovenous fistula (AVF) and arteriovenous graft (AVG) have been
Monitoring of Dialysis recognized as the permanent accesses for a dialysis patient with tunneled cuffed
Access catheter (TCC) being the bridge to obtain a permanent access. A lasting and properly
Lalathaksha Kumbar, functioning access is crucial to provide adequate dialysis to improve the quality of
Jariatul Karim, and life of maintenance hemodialysis patients and to reduce the huge access-related cost
Anatole Besarab[2011] in this population

Does the extracorporeal However, Qb is restricted by vascular access (VA) quality and/or concerns that high
blood flow affect Qb could damage the VA. Taking VA quality into consideration, one can investigate
survival of the the relationshipbetween Qb and VA survival. We analyzed data from 1039 patients
arteriovenous treated by hemodiafiltration over a 21-month period where access blood flow (Qa)
vascular access? measurements were also available at baseline.

Pedro PONCE,1 Daniele Vascular access (VA)-related complications are only second to cardiovascular
MARCELLI,2 Caecilia problems as the primary cause for hospitalization in patients on chronic hemodialysis
SCHOLZ,2[2015] treatment.

The study population comprised 1039 patients undergoing postdilution HDF in 19

Fresenius Medical Care’s NephroCare clinics in Portugal between April 2011 and
January 2013. VA failure was defined as the first surgical intervention that resulted in
the creation of a new VA.

This study did not find a significant association between extracorporeal blood flow
and survival of the VA for the 231 patients dialyzed with AVGs. In comparison,
analysis of VA survival for 808 patients treated via a fistula revealed a significantly
higher risk of VA failure for Qb less than around 310 mL/min and for Qb greater than
around 400 mL/min compared with the reference Qb of 350– 357 mL/min.