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Kidney Week

Abstract: PO1244

Timed Repetitive Controlled Rotations of the CAR-170-C NXSTAGE Chronic Cartridge Hemodialysis Filter: An Original Newfangled Maneuver to Enable Heparin-Free Frequent Daily Home Hemodialysis

Session Information

  • Home Hemodialysis
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 702 Dialysis: Home Hemodialysis

Authors

  • Onuigbo, Macaulay A., Larner College of Medicine, University of Vermont, Burlington, Vermont, United States
  • Locke, Adam, Larner College of Medicine, University of Vermont, Burlington, Vermont, United States
Introduction

Heparin-free hemodialysis is usually obligatory in immediate post-operative states, bleeding diathesis and in critically ill patients. Conventionally, this is achieved through normal saline flushes, and regional citrate anticoagulation.

Case Description

An 87-yo white male with ESRD and atrial fibrillation on Warfarin, on maintenance daily Home Hemodialysis (HHD) with a NxStage machine, developed intra-abdominal abscess and sepsis following an urgent laparoscopic appendicectomy. He required emergent pericardiocentesis for cardiogenic shock from hemorrhagic pericardial effusion. Upon discharge, he was to continue heparin-free HHD. Despite the use of increasing volumes of normal saline flushes, his system clotted every day during HHD, therefore compromising his ability to carry out HHD. Our HD Senior Technician, had astutely observed that by a controlled timed manual and repeated to and fro rotation of the horizontally aligned CAR-170-C NXSTAGE Chronic cartridge, 60 degrees back and forth clockwise and counterclockwise, along the long axis of the filter, every 15 minutes, the filter stopped clotting. He has since then not needed saline flushes for smooth heparin-free HHD for several months.

Discussion

This is the first such report in the English literature. More studies are justified. We have hypothesized a mechanism and have named this the ‘Adam Locke_Onuigbo Maneuver’. If confirmed by subsequent research, we propose that a miniaturized motor set-up that would be programmed to mimic these timed controlled partial rotations of the horizontally aligned CAR-170-C NXSTAGE Chronic cartridge could translate to a commercial success with major clinical benefits to patients needing heparin-free hemodialysis in all settings.