Megan C. Frost

Implantable chemical sensors for real-time clinical monitoring: progress and challenges

Recently, progress has been made in the development of implantable chemical sensors capable of real-time monitoring of clinically important species such as PO(2), PCO(2), pH, glucose and lactate. The need for developing truly biocompatible materials for sensor fabrication remains the most significant challenge for achieving robust and reliable sensors capable of monitoring the real-time physiological status of patients.

Preparation and characterization of implantable sensors with nitric oxide release coatings

The widespread use of miniaturized chemical sensors to monitor clinically important analytes such as PO2, PCO2, pH, electrolytes, glucose and lactate in a continuous, real-time manner has been seriously hindered by the erratic analytical results often obtained when such devices are implanted in vivo. One major factor that has influenced the analytical performance of indwelling sensors is the biological response they elicit when in contact with blood or tissue (e.g. thrombus formation on the device surface, inflammatory response, encapsulation, etc.). Nitric oxide (NO) has been shown to be a potent inhibitor of platelet adhesion and activation as well as a promoter of wound healing in tissue. Herein, we review recent work aimed at the development of hydrophobic NO-releasing polymers that can be employed to coat catheter-type amperometric oxygen sensors without interfering with the analytical performance of these devices. Such modified sensors are shown to exhibit greatly enhanced hemocompatibility and improved analytical performance when implanted within porcine carotid and femoral arteries for up to 16 h. Further, results from preliminary studies also demonstrate that prototype fluorescent oxygen sensors, catheter-style potentiometric carbon dioxide sensors and subcutaneous needle-type enzyme-based amperometric glucose sensors can also be fabricated with new NO-release outer coatings without compromising the analytical response characteristics of these devices. The NO-release strategy may provide a solution to the lingering biocompatibility problems encountered when miniature chemical sensors are implanted in vivo.

Effect of varying nitric oxide release to prevent platelet consumption and preserve platelet function in an in vivo model of extracorporeal circulation.

The gold standard for anticoagulation during extracorporeal circulation (ECC) remains systemic heparinization and the concomitant risk of bleeding in an already critically ill patient could lead to death. Normal endothelium is a unique surface that prevents thrombosis by the release of antiplatelet and antithrombin agents. Nitric oxide (NO) is one of the most potent, reversible antiplatelet agents released from the endothelium. Nitric oxide released from within a polymer matrix has been proven effective for preventing platelet activation and adhesion onto extracorporeal circuits. However, the critical NO release (NO flux) threshold for thrombus prevention during ECC has not yet been determined.1 Using a 4-hour arteriovenous (AV) rabbit model of ECC,2 we sought to find this threshold value for ECC circuits, using an improved NO-releasing coating (Norel-b ). Four groups of animals were tested at variable NO flux levels. Hourly blood samples were obtained for measurement of arterial blood gases, platelet counts, fibrinogen levels and platelet function (via aggregometry). A custom-built AV circuit was constructed with 36 cm of poly(vinyl)chloride (PVC) tubing, a 14 gauge (GA) angiocatheter for arterial access and a modified 10 French (Fr) thoracic catheter for venous access. The Norel-b coating reduced platelet activation and thrombus formation, and preserved platelet function — in all circuits that exhibited an NO flux of 13.65 × 10— 10 mol·cm—2·min—1. These results were significant when compared with the controls. With the Norel-b coating, the NO flux from the extracorporeal circuit surface can be precisely controlled by the composition of the polymer coating used, and such coatings are shown to prevent platelet consumption and thrombus formation while preserving platelet function in the animal. Perfusion (2007) 22, 193—200.

Fabrication and in vivo evaluation of nitric oxide-releasing electrochemical oxygen-sensing catheters

Publisher Summary This chapter describes the procedure employed to construct functional NO-releasing catheter-type amperometric oxygen sensors, including coating the sensor with NO-release materials, assembly of the sensor itself, and in vivo evaluation of the analytical performance and hemocompatibility of the device. The procedure describing the specific fabrication of an intravascular catheter-type sensor that is introduced into an artery via a 14-gauge, 1.16-in. angiocath isdiscussed. In this procedure, the sensor is fixed into a four-way stopcock to allow a means to attach the sensor to the catheter securely and to introduce a saline drip to prevent blood from pooling in the catheter. The length and diameter of the sensor can be adjusted by selecting tubing of the appropriate diameters and adjusting lengths of wires and the sensor body to accommodate a wide variety of sizes and specific methods of introducing the sensor into the blood vessel or tubing to be monitored. Material and procedure for coating sensor sleeves, sensor fabrication, and concepts related to sensor calibration and use are also described.