Sensing Savvy

A vascular access is required in order to have hemodialysis. The three most common types of vascular access are: an arteriovenous fistula (AVF) created by joining a vein and an artery, usually in the arm; an arteriovenous graft (AVG) formed by connecting an artery to a vein with a tube, or a central venous catheter (CVC). Optimally, a fistula or graft will be surgically created several months before dialysis starts, in order to ensure it is ready when it is needed. 

It’s been 10 years since the World Health Organization (WHO) released its surgical care checklist tools to help improve outcomes and decrease postoperative mortality rate. Now, the checklists are receiving a few updates.

A working vascular access is the lifeline for a hemodialysis patient. It is also an Achilles heel, for when it fails, another access (frequently a catheter) must be quickly placed for life preserving hemodialysis to continue. While an arteriovenous fistula (a natural conduit connecting an artery and a vein) is the preferred vascular access, expanded polytetrafluoroethylene (ePTFE) synthetic grafts are frequently used as the second choice for a vascular access, before placing a catheter.

Life-threatening bleeds (LTB) from arteriovenous fistulas or grafts are significant bleeds which are not stopped by application of a normal amount of pressure as is commonly used to stop bleeding after dialysis needle removal. In many cases they occur spontaneously at home between dialysis sessions, away from the clinic or caregiving team. Although access-related LTBs are not common, they can result in the loss of the patient’s access and even be fatal.

The Hospital Readmissions Reduction Program (HRRP) established in the Affordable Care Act has further focused hospital efforts to improve quality and patient outcomes.

In a Medicare Payment Advisory Commission (MedPAC) report to Congress, coronary artery bypass graft (CABG) surgery was ranked as having the highest potentially preventable readmission rate. Volume flow measurement provides an objective, intraoperative assessment of the quality and patency of grafts and could help prevent costly re-operations and readmissions.

Chief, Division of General Thoracic Surgery the Director of the Baylor College of Medicine Lung Institute at CHI St. Luke's Health–Baylor St. Luke's Medical Center in Houston, TX94th
AATS President (2013-2014)

The Centers for Medicare and Medicaid Services (CMS) is striving to improve the efficiency and quality of care for Medicare beneficiaries undergoing CABG surgery. CME also is seeking to elevate collaboration among hospitals, physicians and post-acute care providers to improve the coordination of care for the Medicare patient from the CABG patient’s initial hospitalization through a 90-day recovery period following hospital discharge.

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.

“Not a day goes by when this flowmeter doesn’t solve a problem for me.” - BP Mindich, MD

During coronary artery bypass grafting (CABG), Transonic Flowmeters are used to measure the flow of blood through newly anastomosed bypass grafts.

The International Federation of Health Plans was founded in 1968 by a group of health insurance industry leaders, and is now the leading global network of the industry, with 80 member companies in 25 countries. Its goal is to assist in the maintenance of high ethical and professional standards throughout the industry.