ABSTRACT In this study, eight different manure treatment plants were monitored. The plants were four on-farm and four centralized treatment plants, all of them at full-scale level. Assessment includes a total of seven pre-treatment and process units as follows: mechanical separation, with and without coagulant and flocculant addition, pasteurization, nitrification-denitrification, anaerobic digestion, and composting. The plants are located in nutrient surplus areas of three European Member States (Spain, Italy and Denmark), the majority of these areas being Nitrate Vulnerable Zones (NVZ). Results presented herein are data collected over a six-month period and comprise performance data of the treatment plants, pathogen indicators (E.coli and Salmonella) and greenhouse gas (GHG) emissions data under two scenarios: 1) the baseline scenario and 2) the treatment plant scenario. The assessment includes GHG emissions of the storage facilities, transportation, and subsequent intermediate storage, electric consumption, electric production, composting, and land application. All treatment plants studied generated a significant reduction in GHG emissions (between 53 and 90 %) in comparison to the baseline scenario. Organic matter and total solids (TS) content in manure were also greatly reduced, with values ranging between 35-53 % of chemical oxygen demand (COD) and, 24-61 % of TS for anaerobic digestion (AD) treatment plants, 77-93 % COD and 70 % TS in the case of AD combined with nitrogen (N)-removal unit plants. Nitrogen concentrations were also greatly reduced (between 65-85 %) total Kjeldahl nitrogen (TKN) and 68-83 % ammonium (NH4+-N)) in plants with N-removal units.

Adequate vascular access is essential in order to obtain optimal haemodialysis. The damage caused by conventional needle puncture or intradialytic complications deriving from the movement of the arm can compromise the survival of the access. Another essential factor in the quality of the haemodialysis, closely related to the calibre of the needle, is obtaining a greater efficient blood flow. The fistula catheter, a new puncture cannula made of fluoroplastic, reduces the damage to the internal wall of the access and presents a lower puncture calibre with a higher interior calibre, which allows it to reach better flows with maximum efficiency and fewer vascular complications. The aim of this prospective study was to compare the use of the fistula catheter with the use of the needle. Eighteen haemodialysis sessions were carried out with each of the devices in stable patients with good vascular access, recording in all cases the flow obtained, pressures and other monitor parameters, test results and incidents. The results have shown that the use of the fistula catheter reduced the arterial pressure and venous pressure, without reducing the dialytic efficiency, and consequently the haemodynamic profile improved. The actual blood flow, number of litres dialysed and Kt improved significantly. The lesser mechanical trauma caused in the vascular access made it possible to reduce the dose of heparin, the haemostasis time and there was a reduction in vascular complications: extravasation and rebleeding. While the puncture is well tolerated, there is a slight worsening in the feeling of pain, explained by the lack of experience in handling. The improvement in dynamic parameters opens up the possibilities of achieving greater dialytic efficiency by making it feasible to use greater blood flows with more adequate pressures.

Es imprescindible un acceso vascular adecuado para obtener una hemodiálisis óptima. El daño causado por la punción de la aguja convencional o complicaciones intradiálisis derivadas del movimiento del brazo pueden comprometer la supervivencia del acceso. Otro factor esencial en la calidad de la hemodiálisis, íntimamente relacionado con el calibre de la aguja, es conseguir un mayor flujo sanguíneo eficaz. El catéter-fístula, una nueva cánula de punción de fluoruroplástico, disminuye el daño en la pared interna del acceso y presenta un menor calibre de punción con un mayor calibre interior, lo que le permite alcanzar mayores flujos con una máxima eficacia depuradora y menores complicaciones vasculares. El objetivo de este estudio prospectivo fue comparar el uso del catéter-fístula con el uso de la aguja convencional. Se realizaron 18 sesiones de hemodiálisis con cada uno de los dispositivos en pacientes estables y con buen acceso vascular, recogiéndose en todos los casos el flujo obtenido, las presiones y otros parámetros del monitor, analíticas e incidencias. Los resultados han demostrado que la utilización del catéter-fístula disminuyó la presión arterial y la presión venosa, sin disminuir la eficacia dialítica, en consecuencia, mejoró el perfil hemodinámico. Mejoró significativamente el flujo de sangre real, el número de litros dializados y el Kt. El menor trauma mecánico producido en el acceso vascular permitió disminuir la dosis de heparina, el tiempo de hemostasia y hubo una reducción de las complicaciones vasculares: extravasación y resangrado. Siendo bien tolerada la punción, hay un leve empeoramiento en la sensación dolorosa, justificada por la inexperiencia del manejo. La mejoría en los parámetros dinámicos abren las posibilidades de conseguir mayor eficacia dialítica al hacer factible la utilización de mayores flujos sanguíneos con presiones más adecuadas.