Mary Christiensen moved to the senior citizen’s residence after her husband died. The move had been traumatic. Mary felt uprooted, having left behind friends and the home she and her husband had shared for 42 years. One constant remained from her old life. Three times a week she would be driven to a clinic for hemodialysis, as she had for the seven years when her kidneys failed. Even though the treatments drained her, she welcomed them because she would then feel better for a day or so.
Ultrasound indicator dilution is the current Gold Standard for measurement of vascular access recirculation and access flow;1
- Ultrasound indicator dilution is the method of choice for monthly surveillance of vascular access grafts in adherence to NKF-K/DOQI guidelines
- Available evidence suggests that access flow measurements are the best tests currently available to screen for access dysfunction.
- Monthly surveillance is a cost-effective strategy.
“The access looks good, why should I bother with surveillance?”
Through years of training and practice, nephrologists, interventional radiologists and surgeons have honed keen observation skills. Yes, we all tend to believe what we see. “A picture is worth a 1000 words,” is what we say and we certainly do think what we see is “real.” A measurement, on the other hand, is abstract, hard to get one’s mind around unless one has a reference and, even then, it is often hard to determine if it is actually within an acceptable threshold.
Transonic ultrasound dilution technology revolutionized comprehensive vascular access patency management by enabling routine surveillance to detect decreasing access flows that foreshadow access thrombosis failure. However, the value of surveillance continues to be scrutinized. In assessing the value of surveillance one must not consider surveillance alone, but in the context of the three factors that influence surveillance outcomes. They are: