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Silicone Oil Decreases Biofilm Formation in a Capacitance-Based Automatic Urine Measurement System

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Silicone Oil Decreases Biofilm Formation in a Capacitance-Based Automatic Urine Measurement System sensors Communication Silicone Oil Decreases Biofilm Formation in a Capacitance-Based Automatic Urine Measurement System Martin Slettengren 1,2,* , Martin Linnros 2 and Jan van der Linden 1,2 1 Division of Perioperative Medicine and Intensive Care, Section of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden; [email protected] 2 Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-171 77 Stockholm, Sweden; [email protected] * Correspondence: [email protected] Abstract: Capacitance-based automatic urine measurement is a validated technique already imple- mented in clinical practice. However, albuminuria and free hemoglobinuria cause progressive biofilm buildup on the capacitance sensors of the urinometers. The aim of this experimental study is to investigate the influence of albumin and free hemoglobin on the capacitance signal of an automatic urinometer with and without the addition of silicone oil. A solution of Ringer’s acetate mixed with either albumin or free hemoglobin was run through an automatic urinometer containing either a water-soluble capsule with silicone oil or not. In total, around 500 capacitance measurements were retrieved from the albumin and free hemoglobin group, respectively. The mean increase in capacitance in the albumin 3 g/L group was 257 ± 100 pF without and 105 ± 30 pF with silicone oil, respectively, during 24 h. After ten hours of recording, differences between the two albumin groups reached statistical significance. For the free hemoglobin groups (0.01 g/L), the mean increase in capacitance was 190 ± 170 pF with silicone oil, and 324 ± 80 pF without, with a significant difference between the groups after 20 h and onwards. Coating of the capacitance measurement membrane of the automatic urinometer by albumin or free hemoglobin was significantly decreased by silicone oil, prolonging the functionality of the device. Citation: Slettengren, M.; Linnros, M.; van der Linden, J. Silicone Oil Keywords: silicone oil; electric capacitance; albuminuria; hemoglobinuria; hemolysis; automatic Decreases Biofilm Formation in a urinometer; biofilm Capacitance-Based Automatic Urine Measurement System. Sensors 2021, 21, 445. https://doi.org/10.3390/ s21020445 1. Introduction Received: 3 December 2020 Most vital parameters in today’s intensive care units are recorded automatically, e.g., Accepted: 7 January 2021 blood pressure, heart rate, and temperature. Urine output, an essential part of the fluid Published: 10 January 2021 balance of the body, is, however, still most often recorded manually. This can lead to inaccurate recordings due to human error and/or delay, and also increases the staff’s Publisher’s Note: MDPI stays neu- workload. To mitigate these shortcomings, automatic urinometers have been developed, tral with regard to jurisdictional clai- though based on different techniques: droplet-based [1], electromagnetic switch [2], high- ms in published maps and institutio- precision scale [3], and capacitance [4]. Of these, the last method has proved the most nal affiliations. promising and feasible for clinical use [5,6]. Sippi® (Observe Medical, Gothenburg, Sweden) is an automatic urinometer based on capacitance measurements, consisting of a base unit and an attached disposable unit Copyright: © 2021 by the authors. Li- (Figure1A). censee MDPI, Basel, Switzerland. The urinometer is attached to the urinary catheter from where urine flows into the This article is an open access article antechamber. In the antechamber, the urine dissolves a capsule containing silicone oil that distributed under the terms and con- is transferred with the urine to the measuring chamber located just below. Change in the ditions of the Creative Commons At- capacitance between two sensors is used to estimate the urine volume within the measuring tribution (CC BY) license (https:// chamber. After measurement, the urine departs from the chamber using a siphon technique creativecommons.org/licenses/by/ to a collection bag. This automatic urinometer has previously been validated by our group 4.0/). Sensors 2021, 21, 445. https://doi.org/10.3390/s21020445 https://www.mdpi.com/journal/sensors Sensors 2021, 21, 445 2 of 10 Sensors 2021, 21, x FOR PEER REVIEWregarding measurement accuracy in both the cardiothoracic [5] and pediatric intensive3 careof 10 units [6]. A B Figure 1. (A) Overview of the evaluated new automatic urinometer (Sippi®, Observe Medical, Figure 1. (A) Overview of the evaluated new automatic urinometer (Sippi®, Observe Medical, Gothenburg). (B) The experimental setup. Gothenburg). (B) The experimental setup. TheThe capacitancecircuit was ofassembled a capacitor either is determined with or without by the a sizesilicone and oil the capsule distance in betweenthe ante- itschamber. plates, and The the silicone amount oil andcapsule type was of the dissolv dielectric.ed when In the the automatic studied solution urinometer entered Sippi the®, theantechamber, dielectric consists whereby of the a column silicone of oil urine was intransferred the measuring by the chamber.solution to The the higher measuring the heightchamber, of the where urine it columnadhered into thethe measuringpolypropylene chamber plastic is, walls the higher [18]. Alternatively, the capacitance. the Bysili- measuringcone oil capsule the time was it takesremoved to charge through and a dischargehole created the by capacitor, a soldering a value iron is in acquired the front for of thethe capacitance, antechamber. which Thereafter, relates tothe the hole height was ofsealed the urine with columna 3M tape in thedesigned measuring for plastic chamber. sur- Thefaces. volume Every of 24 urine h, a innew the solution measuring was chamber added to can the then container easily be and calculated the collection by the bag device, was basedemptied. on the change in capacitance. The measurement resolution is 1 mL. 2 ° ® Normally,We used a biofilm medium-viscosity is produced silicone by local oil bacteria(viscosity sticking 350 mm to/s a at surface. 25 C) (Silbione Methods, oils to reduce70047, biofilm-producingV350, Elkem, Oslo, bacteria Norway). include This surfaceoil is a linear modifications polydimethylsiloxane, [7], antimicrobial chemically impreg- natedinert, surfacesheat-resistant, [8], electricity nontoxic, [9 ,and10], has and a substances low surface to tension prevent [19]. the attachment of bacteria to a surface, such as cellobiose dehydrogenase/amylase [11], hydrogels [12], and silver nanoparticles2.2. Albumin [Solution13]. Measures may also target established biofilm, e.g., signal interference be- tweenThe bacteria first [part14], antibiotic-loadedof the study investigated nanoparticles the effect to enhance of an penetrationalbumin solution into biofilm on capaci- [15], andtance biofilm measurements dispersion with (e.g., and Dispersin without B)silicone [16]. Lastly,oil released the mechanical from a capsule. removal Sixty of milliliters biofilm isof an albumin option, (Alburex but it is® not 50 easilyg/L, CSL applied Behring in capacitanceAB, Danderyd, sensors. Sweden) All thesewas diluted options, in except960 mL mechanicalof Ringer’s removal,acetate (Baxter act on International local bacteria Inc, that Deerfield, produce biofilm.MA, USA), In somegiving cases—in a concentration urine, forof 3 instance—proteins g of albumin/L. A new such mixture as albumin with orthe free same hemoglobin concentration, may for directly each Sippi form®-peristaltic a biofilm overpump sensor system, surfaces was withoutproduced the for involvement every 24 h ofmeasurement. bacteria. Removal The mixture of this typewas ofstored biofilm in a is2500 very mL difficult container and, as as described far as we know,above. only The theperistaltic mechanical pump option was iscalibrated available. to achieve a flowA rate problem of approximately when using capacitance42 mL/h, resulting measurements in an estimated to estimate total urine protein volume concentration is that the biofilmof 3 g/24 coating h. The of the albumin–Ringer’s reading membrane acetate will influence solution the was capacitance conducted signal with [17 two], resulting parallel ingroups: false readings, 20 times or with even silicone complete oil and shutdown. 20 time Pilots without. clinical Moreover, tests of the two automatic additional urinome- experi- ® terments Sippi within patientsa lower albumin undergoing concentration, cardiac surgery 0.3 g/L revealed and 1.0 that g/L, measurements respectively, couldwere notcon- beducted. recorded after 24 h in some patients who have albuminuria and/or hemoglobinuria, or a urinary tract infection. By adding a water-soluble capsule containing silicone oil to the2.3. antechamber Free Hemoglobin of the Solution device, these problems seemed to be prevented clinically, and the device could function for the recommended period of use of the disposable unit (1 week). The second part of the study investigated the effect of fHb on capacitance measure- The aim of this study is to investigate whether albumin or free hemoglobin (fHb), ment with and without silicone oil released from a capsule. fHb was acquired from blood common in the urine of patients following cardiac surgery, could influence the capacitance remaining in syringes after routine arterial blood gas analysis in patients. Thirty-nine sep- signal of the automatic urinometer, and whether this could be prevented by adding silicone arate syringes were used. The residual blood from the syringes was centrifuged with a oil to the measuring
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