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Haem odialysis Machines
Blood Volume M onitorBVM
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The technical princ iples of the BVM
BVM continuously determines the blood volumechanges during dialysis, by measuring the time
(figure 3) taken forultrasound pulses totravel through a pre-cisely defined cuvette(figure 5) located inthe arterial blood line,
which is then convertedinto sound speed.
Since the amount ofblood cells and proteins
in the intravascular space does not change duringultrafiltration, the reduction of blood water leadsto an increase in blood density.
As there is a positive correlation betweenthe speed of sound and blood density, anincrease in blood density leads to faster soundspeeds, which are a measure for blood waterconcentration.
This data is used to determine the Relative BloodVolume (RBV), initially set at 100 % and theabsolute Haematocrit and Haemoglobin values.
Based on the patients actual RBV value, theclinically validated control algorithm of the BVMcontinuously adjusts the ultrafiltration rate in
order to prevent the RBV being reduced to anindividual critical level (figure 6, red zone)where hypovolaemia related side effects aremost likely to occur.
During dialysis the actual RBV is also influencedby processes other than ultrafiltration e.g. food
and fluid intake, changes in posture or indialysis fluid osmolarity, which have to be takeninto consideration.
Fig. 3 Determination of the transit time of
ultrasound pulses through blood.
Fig. 6 Course of RBV monit ored by BVM duringa blood volume controlled dialysis.
Fig. 4 The 4008 H haemodialysis machineincluding the BVM m odule.
Fig. 5 Scheme of sensor head.
Chang es in postureand food intake
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Techn ical chang es reserved
Fresenius Medical Care
Else-Krner-Strae 1
D 61352 B ad H omburg
G ermany
D 61346 B ad H omburgP hone: +49 (0) 6172-609-0
Fax: +49 (0) 6172-609-8340
E-M ail: dialysis-marketing@ fmc-ag.com
Internet: http://www.fmc-ag.com
Use of the Blood Volum e M onitor BVM
Relative Blood Volume (RBV) 1.7 % (absolute)
Haematocrit (Hct) 2.9 Hct %*
Haemoglobin (Hb) 0.8 g/dl
Temperature 0.1 C (33.5 40C)
* if plasma protein concentration range is 60-85 g/l
The operation of BVM is very convenient, thanks to an: easy insertion of the BVM cuvette during the lining of
the extracorporeal blood circuit
automatic calibration of the BVM during priming
rapid entry of the Critical RBV value and
initiation of the BVM control by pressing theUF Control key.
The routine use of blood volume management with the BVMhas proven to be a powerful tool in the attempt to reduce
hypotensive episodes.Another important factor for the prevention of Hypotension,is the intradialytic stabilisation of the body temperature, asdemonstrated in recent studies.
A precise, individual and non-invasive control of patient'sbody temperature during dialysis is possible today bymeans of the Blood Temperature Monitor BTM, anotheroptional module of Fresenius Medical Cares concept ofPhysiological Dialysis.
In a unique combination Fresenius Medical Care offers theautomatic control of blood volume and body temperature,two of the major physiological parameters, in order to reduceSymptomatic Hypotension and to improve the interdialyticphysical wellness of dialysis patients.
1. Bhler J :Blutvolumen- und Bluttemperatursteuerung whrend der Hmodialyse.Spektrum der Nephrologie (2001) 4:3-11
2. Daugirdas J T:Dialysis hypotension:A haemodynamic analysis.Kidney Int (1991) 39:223-246
3. Klingel R: Bedeutung der Dialysat- und Bluttemperatur fr die hmodynamischeStabilitt whrend der Hmodialyse. J Nephrol Team (1997) 3:102-105
4. Krmer M:Die Ultraschallmethode zur kontinuierlichen Blutvolumenmessung.Dial J (1997) 16 (59): 152-160
5. Maggiore Q (on behalf of the study group):The Effects of Control of ThermalBalance on Vascular Stability in Hemodialysis Patients:Results of the EuropeanRandomized Clinical Trial.Am J Kidney Dis (2002) 40 (2):280-290
6.Rosales LM, Schneditz D, Morris AT, Rahmati S, Levin NW:Isothermic hemodialysisand ultrafiltration.Am J Kidney Dis (2000) 36 (2):353-361
7. Steuer R, Conis JM:The incidence of hypovolemic morbidity in hemodialysis.D&T (1996) 25, 5:272-281
Technical Data / Accuracy Literature
Fig. 7 The combination of BTM and BVM can reducehypotensive side effects.
Patient