{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:56:41Z","timestamp":1760151401992,"version":"build-2065373602"},"reference-count":19,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T00:00:00Z","timestamp":1646265600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Venous needle dislodgement (VND) is a major healthcare safety concern in patients undergoing hemodialysis. Although VND is uncommon, it can be life-threatening. The main objective of this study was to implement a real-time multi-bed monitoring system for VND by combining a novel leakage-detection device and IoMT (Internet of Medical Things) technology. The core of the system, the Acusense IoMT platform, consisted of a novel leakage-detection patch comprised of multiple concentric rings to detect blood leakage and quantify the leaked volume. The performance of the leakage-detection system was evaluated on a prosthetic arm and clinical study. Patients with a high risk of blood leakage were recruited as candidates. The system was set up in a hospital, and the subjects were monitored for 2 months. During the pre-clinical simulation experiment, the system could detect blood leakage volumes from 0.3 to 0.9 mL. During the test of the IoMT system, the overall success rate of tests was 100%, with no lost data packets. A total of 701 dialysis sessions were analyzed, and the accuracy and sensitivity were 99.7% and 90.9%, respectively. Evaluation questionnaires showed that the use of the system after training changed attitudes and reduced worry of the nursing staff. Our results show the feasibility of using a novel detector combined with an IoMT system to automatically monitor multi-bed blood leakage. The innovative concentric-circle design could more precisely control the warning blood-leakage threshold in any direction to achieve clinical cost-effectiveness. The system reduced the load on medical staff and improved patient safety. In the future, it could also be applied to home hemodialysis for telemedicine during the era of COVID-19.<\/jats:p>","DOI":"10.3390\/s22051988","type":"journal-article","created":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T20:36:30Z","timestamp":1646339790000},"page":"1988","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Real-Time Internet of Medical Things System for Detecting Blood Leakage during Hemodialysis Using a Novel Multiple Concentric Ring Sensor"],"prefix":"10.3390","volume":"22","author":[{"given":"Hsiang-Wei","family":"Hu","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering, National Cheng Kung University, Tainan 704, Taiwan"},{"name":"International Academia of Biomedical Innovation Technology, Taipei 104, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chih-Hao","family":"Liu","sequence":"additional","affiliation":[{"name":"AcuSense BioMedical Technology Corp., Tainan 744, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6087-4610","authenticated-orcid":false,"given":"Yi-Chun","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, National Cheng Kung University, Tainan 704, Taiwan"},{"name":"Medical Device Innovation Center, National Cheng Kung University, Tainan 701, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kuan-Yu","family":"Chen","sequence":"additional","affiliation":[{"name":"International Academia of Biomedical Innovation Technology, Taipei 104, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8095-7870","authenticated-orcid":false,"given":"Hsuan-Ming","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Nephrology, An Nan Hospital, China Medical University, Tainan 709, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3070-5787","authenticated-orcid":false,"given":"Chou-Ching","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, National Cheng Kung University, Tainan 704, Taiwan"},{"name":"Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,3]]},"reference":[{"key":"ref_1","unstructured":"National Academies of Sciences Engineering and Medicine (2018). The critical health impacts of corruption. Crossing Glob Qual Chasm: Improving Health Care Worldwide, National Academies Press."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1016\/S0140-6736(16)31012-1","article-title":"Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980\u20132015: A systematic analysis for the Global Burden of Disease Study 2015","volume":"388","author":"Wang","year":"2016","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S9","DOI":"10.5688\/ajpe808S9","article-title":"Annual Report 2016","volume":"80","author":"Se","year":"2016","journal-title":"Am. J. Pharm. Educ."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1111\/j.1537-2995.2009.02518.x","article-title":"Activity-based costs of blood transfusions in surgical patients at four hospitals","volume":"50","author":"Shander","year":"2010","journal-title":"Transfusion"},{"key":"ref_5","first-page":"435","article-title":"Venous needle dislodgement in patients on hemodialysis","volume":"39","author":"Axley","year":"2013","journal-title":"Nephrol. Nurs. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1111\/j.1755-6686.2008.00047.x","article-title":"Venous needle dislodgement: How to minimise the risks","volume":"34","author":"Chamney","year":"2008","journal-title":"J. Ren. Care"},{"key":"ref_7","unstructured":"American National Standard AAMI (2021, November 19). Hemodialysis Systems. Available online: https:\/\/www.k-space.org\/ymk\/hemodialysis1.pdf."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1111\/j.1542-4758.2008.00263.x","article-title":"A new safety device for hemodialysis","volume":"12","author":"Ahlmen","year":"2008","journal-title":"Hemodial. Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1111\/j.1755-6686.2005.tb00434.x","article-title":"Summary of the EDTNA|ERCA. Journal Club discussion: Summer","volume":"2005","author":"Lindley","year":"2005","journal-title":"EDTNA-ERCA J."},{"key":"ref_10","unstructured":"(2021, November 19). Available online: https:\/\/onlinelibrary.wiley.com\/doi\/abs\/10.1111\/j.1755-6686.2005.tb00434.x."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Du, Y.C., Lim, B.Y., Ciou, W.S., and Wu, M.J. (2016). Novel Wearable Device for Blood Leakage Detection during Hemodialysis Using an Array Sensing Patch. Sensors, 16.","DOI":"10.3390\/s16060849"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e150","DOI":"10.2196\/jmir.7131","article-title":"Using a Medical Intranet of Things System to Prevent Bed Falls in an Acute Care Hospital: A Pilot Study","volume":"19","author":"Balaguera","year":"2017","journal-title":"J. Med. Internet Res."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Ou, Y.K., Wu, M.J., Ciou, W.S., and Du, Y.C. (2019). A Clinical Trial of the Effect of a Blood Leakage Detection Device for Patients during Hemodialysis. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16132388"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Hiremath, S., Yang, G., and Mankodiya, K. (2014, January 3\u20135). Wearable Internet of Things: Concept, Architectural Components and Promises for Person-Centered Healthcare. Proceedings of the 2014 4th International Conference on Wireless Mobile Communication and Healthcare-Transforming Healthcare through Innovations in Mobile and Wireless Technologies 2014, Athens, Greece.","DOI":"10.4108\/icst.mobihealth.2014.257440"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1007\/s11255-020-02609-5","article-title":"Quality indicators of vascular access procedures for hemodialysis","volume":"53","author":"Fila","year":"2020","journal-title":"Int. Urol. Nephrol."},{"key":"ref_16","first-page":"546","article-title":"Performance measures for binary classification","volume":"1","author":"Berrar","year":"2019","journal-title":"Encycl. Bioinforma. Comput. Biol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1148\/radiol.2251011367","article-title":"Hemodialysis arteriovenous fistula maturity: US evaluation","volume":"225","author":"Robbin","year":"2002","journal-title":"Radiology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e21","DOI":"10.2196\/humanfactors.7078","article-title":"Remote Monitoring Systems for Chronic Patients on Home Hemodialysis: Field Test of a Copresence-Enhanced Design","volume":"4","author":"Liu","year":"2017","journal-title":"JMIR Hum. Factors"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e19493","DOI":"10.2196\/19493","article-title":"Telehealth for Noncritical Patients with Chronic Diseases During the COVID-19 Pandemic","volume":"22","author":"Liu","year":"2020","journal-title":"J. Med. 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