Scheme of hepato-splanchinc contribution for hemodynamic stability.

<p>Splanchnic vasoconstriction reduces arterial inflow (black arrows) thereby lowering downstream distending pressures and mobilizing blood volume (white arrows) sequestered in the compliant splanchnic vasculature. At the same time reduced portal vein flow draining form splanchnic vascular beds (purple) causes a compensatory increase (red arrow) in the separate hepatic arterial blood flow (red) because of compensatory vasodilation in Mall´s space.</p

Time course of hepato-splanchnic hemodynamics.

<p>Time course of splanchnic vascular resistance index (<i>RI</i>) (top panel) and hepato-splanchnic perfusion index (<i>QI</i>) (bottom panel) measured at times <i>t</i>₁ through <i>t</i>₄ during dialysis in diabetic (red symbols) and non-diabetic (green symbols) subjects. Symbols represent average values ± standard deviations of duplicate measurements obtained in treatments separated by one week. For clarity, symbols for diabetics and non-diabetics are placed with a small left or right offset from the actual measuring times.</p

Hepato-splanchnic perfusion and resistance.

<p>Splanchnic perfusion index (<i>QI</i>) as function of hepato-splanchnic resistance index (<i>RI</i>) (top panel) and hepato-splachnic vascular conductance (bottom panel), respectively, during hemodialysis, in diabetic (red symbols) and non-diabetic (green symbols) subjects. Broken lines indicate the best fit of <i>QI</i> to <i>RI</i> (top panel, <i>y</i> = 6.71/<i>x</i>, <i>r</i>² = 0.77) and 1/<i>RI</i> (bottom panel, <i>y</i> = 0.02+6.54<i>x</i>, <i>r</i>² = 0.77), respectively.</p

Results of catheter content (‘lock’) analysis in varying catheter positions.

<p>^a The centrifuged catheter content was assessed for precipitation with a visual score, ranging from +++ (much) to – (none).</p><p>^b No green staining or precipitation was observed in catheter content samples in jugular (subclavian)-vertical position.</p><p>^c All catheter content (‘lock’) samples of jugular (subclavian) recumbent/head down tilt or femoral vertical position showed green colour indicating plasma influx into the catheter. Precipitation was only present if ethanol lock solutions were used with concentrations above 28%. Plasma sample characteristics: total protein 5.3 g/dL, albumin 3.1 g/dL and density 1.0197 g/cm³ at 37°Celsius.</p

Dilution studies.

<p>The arrow indicates the precipitated protein within the tube (V0) after centrifugation of the test solution consisting of 1 mL plasma and 4 mL ethanol 70%. Concentrations decrease from left to right. Tubes with test solutions containing ethanol locks of ≤28% in the dilution series (V6 toV9) revealed no signs of precipitation. The test series was performed at room temperature (24°C).</p

Results of in-vitro protein precipitation tests (dilution studies).

<p>^a Test solutions consisted of 1 ml plasma (or serum) and 4 ml ethanol lock solution (V0– V9, concentrations ranged from 70 to 7%).</p><p>^b mimicking the conditions inside the catheter. Tests were conducted at room and body temperature.</p><p>^c Precipitation was assessed with a visual score, ranging from +++ (much) to – (none).</p><p>^d Blood sample characteristics: hematocrit 0,42; albumin 4.5 g/dl; total protein 6.5 g/dl.</p

Protein analysis of precipitates.

<p>Representative silver-stained SDS-PAGE gel of protein precipitates. Lanes correspond to serum precipitated with 70% ethanol (S1) or 35% ethanol (S2), lithium-heparin plasma precipitated with 70% ethanol (H1) or 35% ethanol (H2), and citrate plasma precipitated with 70% ethanol (C1) or 35% ethanol (C2).</p

Relative catheter positions and plasma influx.

<p>a) If the venous insertion point (y) is higher relative to the tip (x), there is no plasma or in-vivo whole blood influx b) If the venous insertion point is lower (y) relative to the tip (x) plasma or in-vivo whole blood enters the lumens of the catheter (as indicated by green colour). The same relative catheter position can be assumed for patients in upright position with femoral catheters.</p