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Sensing Savvy

Deborah Brouwer-Maier RN, CNN

Deborah Brouwer-Maier is a nephrology nurse for more than 30 years. Her area of expertise is hemodialysis vascular access. She served on the KDOQI Vascular Access Work Groups in 1997, 2000 and 2006. She also served in various volunteer roles for the Fistula Frist Initiates since the formation of the initial Work Group. She is the support for the Hemodialysis Circle of Care Transonic products to support access creation, surveillance and preservation.

Recent Posts

4 Technologies That Could Influence the Future of Kidney Care

Posted by Deborah Brouwer-Maier RN, CNN on Jul 3, 2017 8:30:00 AM

What if dialysis was mobile and automated? What if you could install a shunt without the chance of rejection or infection? What if we only needed patient tissue cells to procure a new, viable kidney? The future of kidney care holds all these possibilities and more due to research in stem cell, bio-tissue and genome technology. Researchers are predicting new modalities of dialysis, gene modification and stem cell-generated tissue as the next steps for a healthier life for our kidney disease patients.

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Topics: kidney care

Study: Best Outcomes When AVF Flows Restricted to Median Range

Posted by Deborah Brouwer-Maier RN, CNN on Jun 28, 2017 6:30:00 AM

A study published in PLOS ONE in March 2017 by clinicians from Huazhong University of Science and Technology in Hubei, China, investigated the association between AVF flows and inflammation, cardiovascular events and deaths in Chinese hemodialysis patients who have a radio-cephalic fistula (AVF). They recognized that AVF flows impact dialysis adequacy in hemodialysis patients. But there was limited data for different access flow levels on outcomes related to long-term dialysis Chinese patients.

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Topics: Hemodialysis, Cardiovascular

Rule of Sixes Key to Successful HD Cannulation

Posted by Deborah Brouwer-Maier RN, CNN on Jun 26, 2017 7:00:00 AM

The KDOQI Work Group and Dr. Michelle L. Robbin from the University of Alabama at Birmingham, offer valuable guidelines for successful hemodialysis cannulation of fistulas in end-stage-renal-disease (ESRD) patients. It is recommended that a 4 mm or greater vessel diameter and flow of 500 mL/min or greater is needed to support successful hd cannulation and dialysis blood flow rates. Ultrasound is not needed for cannulation. Also suggested is the following Rule of Sixes:

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Topics: Hemodialysis

Endovascular Catheter Is Valuable for Measuring Access Flow

Posted by Deborah Brouwer-Maier RN, CNN on Jun 14, 2017 7:00:00 AM

Dr. Lymaris GarcÌa-Medina and colleagues from the Universitario Reina Sofia General Hospital in Murcia, Spain analyzed the flow values measured by the Transonic ReoCath® Flow Catheter to determine whether the ReoCath’s measurements were more reliable than angiographic and clinical findings for planning and determining the outcome of invasive radiologic treatments of hemodialysis fistulas.

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Topics: Catheter Adequacy, VA Flow & Patency

Fistulography, Intra-access Blood Flow Measurement Correlations

Posted by Deborah Brouwer-Maier RN, CNN on Jun 12, 2017 6:30:00 AM

The success of percutaneous transluminal angioplasty (PTA) in stenotic hemodialysis prosthetic grafts and autogenous fistulas is traditionally assessed by the post-intervention vessel diameter of the grafts or fistulas. Interventionalists at the University of San Diego sought to compare this traditional measure of success (vessel diameter), and pre- and post-intervention real-time intra-access blood flow rates with access blood flow measured during hemodialysis.

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Topics: Blood Flow Measurement

Is Timing a Factor In Flow Measurements Performed During Hemodialysis?

Posted by Deborah Brouwer-Maier RN, CNN on Jun 7, 2017 6:30:00 AM

NKF-KDOQI guidelines recommend that the vascular access flow assessment be performed during the first 90 minutes of hemodialysis to eliminate error caused by decrease in cardiac output or blood pressure related to ultrafiltration and/or hypotension. This measurement time restriction to within the first 90 minutes limits the number of measurements that can be performed by one operator, which is a significant issue in clinical practice.

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Topics: Hemodialysis

Hemodialysis in Children: Dedicated Pediatric Vascular Access Clinics Are Key to Success

Posted by Deborah Brouwer-Maier RN, CNN on Jun 7, 2017 6:30:00 AM

Children undergoing hemodialysis present unique challenges for dialysis providers. Hemodialysis in children presents challenges: Little is known about their ideal vein and artery sizes, maturation times and expected volume flow rates to achieve a functioning fistula.

After clinicians at London’s Great Ormond Street Hospital for Children reviewed the outcomes of 25 children who received an arteriovenous fistula (AVF), they found that five had primary AVF failure, and three had secondary AVF failure.

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Topics: Hemodialysis

Which Is Better, Percutaneous Transluminal Angioplasty or Surgical Repair?

Posted by Deborah Brouwer-Maier RN, CNN on May 31, 2017 6:30:00 AM

Two of the most common options for treating a vascular access stenosis in hemodialysis patients are percutaneous transluminal angioplasty (PTA) and fistula reconstruction/revision surgery. Because it is more convenient, PTA has become preferable to surgical revision.

To examine the efficacy of and compare percutaneous transluminal angioplasty or surgical repair, clinicians from three hospitals in Taiwan investigated the duration of fistulas and maintenance costs for dialysis patients. Their study was published in the 2017 February issue of the Journal of Vascular Access.

In the study, charts were reviewed retrospectively from 544 hemodialysis patients from two dialysis units in a teaching hospital in the southern area of Taiwan. Researchers analyzed the frequency of PTA or revascularization surgery and the use of related medical resources.

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Topics: Hemodialysis

Your Hemodialysis Access: A Lifeline for a Lifetime

Posted by Deborah Brouwer-Maier RN, CNN on May 29, 2017 7:00:00 AM

It only takes minutes to save your hemodialysis access, your lifeline. All you have to do is look, listen, feel and then also measure.

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Topics: Hemodialysis

Kidney Care News to Know

Posted by Deborah Brouwer-Maier RN, CNN on May 24, 2017 7:00:00 AM

DaVita Appoints Robert Lang President of International Market

Before joining DaVita, Lang led the international markets business at insurance provider Bupa. He has experience working in Europe, the Middle East, Asia and Latin America.

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Topics: Hemodialysis