Abstract
The use of a new generation of blood oxygenator design using plastic fibers for the heat exchange material is growing. The benefits of a plastic heat exchange material are improved biocompatibility and performance over some of the traditional metals used.
During the initial period of clinical use of one of these new oxygenators, there were reports of four blood-to-water leaks. No patient complications were associated with these leaks, but the product was withdrawn from the market. After a thorough evaluation, the cause of the leaks was found to be an electrostatic discharge that occurred within the heat exchanger during priming of the extracorporeal circuit.
It was found that an electrostatic potential between the blood path and the water path of the heat exchanger is generated as the prime solution is recirculated by a roller pump with polyvinyl chloride (PVC) pumphead tubing. The magnitude of the potential generated was found to vary with the make and model of the roller pump. If this voltage exceeds the dielectric strength of the fiber, a discharge through the wall of a single heat exchange fiber will occur and produce a hole.
Several solutions to this problem of roller pumps generating an electrostatic charge when used with PVC pumphead tubing were identified. Centrifugal blood pumps and roller pumps using silicone rubber pumphead tubing were found to generate no significant electrostatic potential between the blood path and the water path. Another solution, a charge equalization line (CEL), was designed to provide a conductive path for the charge to equilibrate across the fiber wall. The CEL can be either external or internal to the oxygenator.
Each of these solutions was validated and the product has been reintroduced for clinical use.
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