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Sensing Savvy

Is Access Surveillance Worthwhile?

Posted by Susan Eymann, MS on Mar 1, 2019

Transonic ultrasound dilution technology revolutionized comprehensive vascular access patency management by enabling routine surveillance to detect decreasing access flows that presage access thrombosis failure.2-6 However, the value of vascular access access surveillance worthwhile surveillance continues to spark a spirited debate within the nephrology community with skeptics of surveillance challenging its value and proponents lauding its value.

Studies that attest to the value of vascular access surveillance coupled with early intervention, to reduce the thrombosis rate in both fistulas and grafts include the following:

Tessitore 20087: 5-year controlled cohort study: “Adding access blood flow surveillance to clinical monitoring reduces thrombosis rates and costs, and improves fistula patency in the short term.”

“Adding Qa surveillance to monitoring in mature AVFs is associated with a better detection and elective treatment of stenosis, and lower thrombosis rates and access-related costs, although the cumulative access patency was only extended in the first 3 years after fistula maturation.”

Wijnen 20068: “Impact of a quality improvement programme based on vascular access flow monitoring on costs, access occlusion and access failure.”

“A quality improvement programme based on periodical access flow measurement reduced the number of acute vascular access failures due to thrombotic events and also significantly reduced health care costs in patients with AVG, but not in patients with AVF.”

McCarley 20014: “Vascular Access Blood Flow Monitoring Reduces Access Morbidity and Costs.”

“that vascular access blood flow measurement (VABFM) for early detection of vascular access malfunction coupled with preventive intervention reduces thrombosis rates in both polytetrafluoroethylene (PTFE) grafts and native AVFs. While there was a significant increase in the number of angioplasties performed during the flow monitoring phase, the comprehensive cost is markedly reduced due to the decreased number of hospitalizations, catheters placed, missed treatments, and surgical interventions. Vascular access blood flow monitoring along with preventive interventions should be the standard of care in chronic hemodialysis patients.”

Garland 20029 “Are hemodialysis access flow measurements by ultrasound dilution the standard of care for access surveillance?”

“that access flow measurements are the best tests currently available to screen for access dysfunction, and as preventative interventions, such as angioplasty and surgery, are successful, they should be regarded as the present standard of care. Furthermore, the method of choice for access flow measurement is by ultrasound dilution technology.”

Tessitore 201410 “The Rise and Fall of Access Blood Flow Surveillance in Arteriovenous Fistulas”

“Access flow surveillance affords a significant 2- to 3-fold reduction in the risk of thrombosis compared to clinical monitoring alone.”

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References:
  1. AVFFlowSurveillanceWorthwhile (DL-22-wp) RevA 2013 Transonic Systems Inc.
  2. National Kidney Foundation. NKF-K/DOQI Clinical Practice Guidelines for Vascular Access: update 2006 Am J Kidney Dis 2006; 48 (Suppl 1) S176-276.
  3. Collins AJ, Roberts TL, Peter WL et al, United States Renal Data System Assessment of the Impact of the National Kidney Foundation-Dialysis Outcomes Quality initiative Guidelines. Am J Kidney Dis 39: 784-795, 2002.
  4. McCarley P et al, “Vascular Access Blood Flow Monitoring Reduces Access Morbidity and Costs,” Kidney Int; 60(3): 1164-1172, 2001. (Transonic Reference # HD202A)
  5. Bethard GA, “The Treatment of a Vascular Access Graft Dysfunction: A Nephrologistís View and Experience,î Adv Ren Replace Ther 1: 131-147, 1994.
  6. Schwab SJ et al,, “Hemodialysis Arteriovenous Access: Detection of Stenosis and Response to Treatment by Vascular Access Blood Flow,” Kid Int 59(1) 358-362, 2001 (Transonic Reference # HD172A)
  7. Tessitore N et al, ìAdding access blood flow surveillance to clinical monitoring reduces thrombosis rates and costs, and improves fistula patency in the short term: a controlled cohort study,î Nephrol Dial Transplant 2008; 23(11): 3578-84. (Transonic Reference: HD7639A
  8. Wijnen E et al, ìImpact of a quality improvement programme based on vascular access flow monitoring on costs, access occlusion and access failure,î Nephrol Dial Transplant 2006; 21(12): 3514-9. (Transonic Reference # HD7340A).
  9. Garland JS et al, “Are hemodialysis access flow measurements by ultrasound dilution the standard of care for access surveillance?” Adv Renal Replace Ther 2002; 9(2): 91-98. (Transonic Reference: HD263A)
  10. Tessitore N et al, ìThe Rise and Fall of Access Blood Flow Surveillance in Arteriovenous Fistulas, î Semin Dial. 2014 Feb 5,. (Transonic Reference # HD9962AH)

Topics: KDOQI

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