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Sensing Savvy

Debbie Brouwer-Maier Offers Her Perspective on Kidney Care Issues

Posted by Deborah Brouwer-Maier RN, CNN on Jun 7, 2019

As a nephrology professional who has devoted countless hours of volunteer time to support the body of work reflected in the 2006 National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines on vascular access, it is difficult to witness the “march of time” with regards to the arteriovenous fistula (AVF) as the best access for patients on dialysis.

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Topics: KDOQI

All Surveillance Methods Are Not Comparable

Posted by Susan Eymann, MS on Jun 6, 2019

A serious error in the 2019 proposed National Kidney Foundation’s (NKF) Kidney Disease Outcomes Quality Initiative (KDOQI) is their grouping of all methods of vascular access surveillance as comparable. They are not! For instance, venous pressure measurements (Vasc Alert), can identify an outflow vascular access stenosis but cannot detect an inflow stenosis. In contrast, Transonic’s indicator dilution measurements can identify inflow and outflow stenoses as well as stenoses between the needles. This is significant because Asif et al, reported in his 2005 study “Inflow stenosis in arteriovenous fistulas and grafts: a multicenter, prospective study,” that 35% of vascular accesses sent for intervention do have inflow stenosis.1

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Topics: KDOQI

Basis for Proposed KDOQI Guidelines Recommendation on Physical Examination

Posted by Susan Eymann, MS on Jun 5, 2019

The 2019 proposed National Kidney Foundation’s (NKF) Kidney Disease Outcomes Quality Initiative (KDOQI) recommends a regular physical examination by a knowledgeable and experienced health practitioner to detect flow dysfunction. The proposed Guidelines cite five references to support their position.1-5 Asif’s 2005 reference “Accuracy of physical examination in the detection of arteriovenous fistula stenosis” from the Miller School of Medicine at the University of Miami was referenced several times. Two other studies3-4 also originated at that same institution. All four studies1-4 cited the use of interventionalists, interventionalist fellows, or physicians trained in vascular access physical examinations to monitor for and detect AV-access flow dysfunction.

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Topics: KDOQI

Process of Care, Part II: The Impact of Proposed KDOQI Guidelines

Posted by Deborah Brouwer-Maier RN, CNN on May 29, 2019

Dialysis facilities typically open early in the morning Monday to Saturday. The first shift of patients must get their treatments initiated to prevent delays for the later patient shifts. Commonly, limited licensed nursing staff is on duty to perform any needed early morning assessments. The One Minute Check has now been shortened to 10 seconds in some facilities in order to save time. Once the needles are placed, it is not safe to perform the check or a higher-level expert examination. Typically, the nephrologist and advance practice team members see dialysis patients once they are on their way to treatment. They may be able to assess later shift patients before their needles are inserted. However, routine process of care makes it very difficult for nephrologists to fully assess the AVF or AVG with an expert-level physical exam detailed in the current draft of the KDOQI Guideline updates.

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Topics: KDOQI

Process of Care, Part I: Hemodialysis Vascular Access Process of Care Overview

Posted by Deborah Brouwer-Maier RN, CNN on May 27, 2019

A quick review of the process of care is critical to understand how the proposed KDOQI Vascular Access Guidelines will impact the dialysis facilities and thus the patients.

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Topics: KDOQI

Randomized Controlled Trial Confirms Value of Surveillance

Posted by Susan Eymann, MS on May 22, 2019

The value of vascular access surveillance has been widely debated over the past decade. Many studies attest to its usefulness for identifying stenoses. A few question its value. 

A 2015 randomized controlled trial (RCT) by Aragoncillo published in Journal of Vascular Surgery underscores the value of regular surveillance of hemodialysis patients.

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Topics: KDOQI

Advocate for Surveillance in the new 2019 KDOQI Guidelines

Posted by Susan Eymann, MS on May 20, 2019

The proposed 2019 Kidney Disease Outcomes Quality Initiative (KDOQI) Guidelines are now open for review with comments accepted through June 7, 2019. Transonic hopes hemodialysis stakeholders who have pre-registered to review the proposed Guidelines will submit their comments by the June 7th deadline.

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Topics: KDOQI

Access Thrombosis Causes Major Problems for the Patient, Care Staff and Nephrologist

Posted by Susan Eymann, MS on Mar 29, 2019

When an access suddenly clots or thromboses, all stakeholders are confronted with a crisis that must be immediately resolved.

Needless to say, the end-stage renal disease (ESRD) patient has the most at stake and can suffer the most. He or she must cope with:

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Topics: KDOQI

Why Surveillance is Important – Tests Accuracy of Pump Flow

Posted by Susan Eymann, MS on Mar 27, 2019

When one sets the pump on a hemodialysis machine, one naturally assumes that the pump will deliver what it is set at. However, myriad factors can alter the pump flow so the flow being actually delivered to the patient is not the flow the pump is set at. These factors include the following:

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Topics: KDOQI

Why Surveillance is Important: 8 Ways Vascular Access Surveillance Informs the Nephrologist

Posted by Susan Eymann, MS on Mar 25, 2019

“A hemodynamically significant stenosis is the substrate for thrombosis by reducing flow, increasing turbulence, and increasing platelet activation and residence time against the vessel wall.” KDOQI Guidelines 2006

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Topics: KDOQI

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