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Sensing Savvy

Congestive Heart Failure in Hemodialysis Patients with Excellent Fistulas

Posted by Susan Eymann, MS on Mar 20, 2019 7:30:00 AM

Congestive heart failure (CHF) and pulmonary hypertension are well-known complications of high-flow hemodialysis access. Although ‘high flow’ is subjective, since every patient has a threshold of access flow that will induce such failure (as well as distal extremity ischemia), Fistula First uses a minimal threshold of 2 L/min flow to refer the patient for cardiac evaluation.

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Topics: KDOQI

Why Surveillance is Important –Checks for Cardiac Overload

Posted by Susan Eymann, MS on Mar 19, 2019 7:30:00 AM

“The ability to monitor cardiac output is one of the important cornerstones of hemodynamic assessment ...in particular in patients with pre-existing cardiovascular comorbidities.”1

Mortality rates of cardiovascular disease patients on hemodialysis are approximately 30 times that of the general population. Cardiovascular disease (CVD) accounts for half of the deaths and one-third of hospitalizations of these dialysis patients. Their congestive heart failure results from cardiac overload, anemia, severe hypertension and cardiac dysfunction due to the rapid removal of large volumes of fluid during hemodialysis that severely tests the limits of a patient’s cardiac function, which can change dramatically during a hemodialysis treatment.2-5

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Topics: KDOQI

Catheter Patient’s Treatment Is Optimized with Flow-QC Delivered Flow and Recirculation Tests

Posted by Susan Eymann, MS on Mar 15, 2019 7:30:00 AM

A 75-year-old female patient with a central venous catheter underwent a Flow-QC test with a Transonic Hemodialysis Monitor. Her blood lines were in a normal line position. The pump setting on the hemodialysis machine was 290 mL/min. The Flow-QC test measured Delivered Blood Flow at 190 mL/min along with no recirculation.

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Topics: KDOQI

All Surveillance Methods Are Not Equal

Posted by Susan Eymann, MS on Mar 14, 2019 7:30:00 AM

“Very high reproducibility and negligible impact of flow (Qb) on vascular access flow (QVA) determination justifies the current ultrasound dilution status as a reference method in QVA evaluation.” Lopot et al1

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Topics: KDOQI

Why Surveillance is Important: 9 Ways that Surveillance Assures Dialysis Adequacy

Posted by Susan Eymann, MS on Mar 13, 2019 7:30:00 AM

“Any access recirculation is abnormal. Recirculation … should have prompt investigation of its cause. … If access recirculation values exceed 20%, correct placement of needles should be confirmed before conducting further studies.” http://www.kidney.org/professional/KDOQI/guidelineñupHDñVA/index.htm

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Topics: KDOQI

Is Surveillance Valuable: A Critical Review

Posted by Susan Eymann, MS on Mar 11, 2019 7:30:00 AM

As the value of surveillance in managing vascular accesses is undergoing scrutiny, a critical review by distinguished leaders in the field including Drs. A Besarab, A Asif, P Roy-Chaudhury, LM Spergel and P Ravani responds to the skepticism about access surveillance.

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Topics: KDOQI

Transonic VA Surveillance Identifies Patients at Risk

Posted by Susan Eymann, MS on Mar 8, 2019 7:30:00 AM

“Adequate blood flow in peripheral hemodialysis fistulae and grafts is vital to the success of hemodialysis and to the survival of the patient. Reduction in flow ... presages failure of the access device itself. Access flow can therefore be considered a fundamental property of the access that should be monitored.” Depner TA, MD, UC Davis

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Topics: KDOQI

Why Surveillance is Important for a Clinic and Its Staff

Posted by Susan Eymann, MS on Mar 6, 2019 7:30:00 AM

“The Transonic Flow-QC Hemodialysis Monitor has benefited numerous dialysis-dependent patients by reducing and, in many cases, eliminating the agony of a clotted AV graft or fistula, thereby facilitating correction of access stenoses on an elective basis that prevents missed dialysis and the need for placing temporary catheters.”

Thomas Depner, MD, UC Davis

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Topics: KDOQI

Why Transonic Surveillance is Important – What the Experts Say

Posted by Susan Eymann, MS on Mar 4, 2019 7:30:00 AM

The Transonic Flow-QC Hemodialysis Monitor has benefited numerous dialysis-dependent patients by reducing and, in many cases, eliminating the agony of a clotted AV graft or fistula, thereby facilitating correction of access stenoses on an elective basis that prevents missed dialyses and the need for placing temporary catheters.” Depner T, MD, UC Davis

“QA-based surveillance combining Doppler ultrasound and ultrasound dilution reduces the frequency of thrombosis, is cost effective, and improves thrombosis free and secondary patency in autologous AV.”Aragoncillo I et al, “Adding access blood flow surveillance reduces thrombosis and improves arteriovenous fistula patency: a randomized controlled trial,” J Vasc Access. 2017 Apr 20:0. (Transonic Reference # HD11190)

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Topics: KDOQI

Is Access Surveillance Worthwhile?

Posted by Susan Eymann, MS on Mar 1, 2019 7:30:00 AM

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 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:

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Topics: KDOQI

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