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Sensing Savvy

5 Ways Huddles Can Benefit Your Dialysis Clinic

Posted by Deborah Brouwer-Maier RN, CNN on Jul 12, 2017 8:30:00 AM

Football fans probably are very familiar with the concept of a team huddle and its role in a successful game. Although your dialysis clinic isn’t a football field, huddles are key to improving and sustaining quality care. Today, we’ll give a quick definition of a huddle, and look at five ways huddles can benefit your dialysis clinic.

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Topics: VA Flow & Patency

Endovascular Catheter Is Valuable for Measuring Access Flow

Posted by Deborah Brouwer-Maier RN, CNN on Jun 14, 2017 7:00:00 AM

Dr. Lymaris GarcÌa-Medina and colleagues from the Universitario Reina Sofia General Hospital in Murcia, Spain analyzed the flow values measured by the Transonic ReoCath® Flow Catheter to determine whether the ReoCath’s measurements were more reliable than angiographic and clinical findings for planning and determining the outcome of invasive radiologic treatments of hemodialysis fistulas.

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Topics: Catheter Adequacy, VA Flow & Patency

AV Access: A Blessing or a Curse?

Posted by Susan Eymann, MS on Jul 11, 2016 7:00:00 AM

There is general consensus that the AV fistula is the preferred vascular access for end-stage renal disease patients undergoing hemodialysis. The AV fistula has been associated with reduced hospitalizations for AV access failure, fewer missed treatments, fewer invasive surgical procedures, fewer infections and reduced costs compared with vascular access grafts or catheters. On the Fistula First/Catheter Last website, the arteriovenous fistula is called the “Lifeline for a Lifetime.”

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Topics: VA Flow & Patency, Hemodialysis

Using a Twister to Measure Access Flow without Reversing Bloodlines

Posted by Susan Eymann, MS on Jan 26, 2016 6:30:00 AM

You can measure vascular access flow with your HD02/HD03 Hemodialysis Monitor on any manufacturer’s blood tubing set by using a Fresenius Medical Care TwisterTM CombiSet bloodline or the stand alone TwisterTM accessory. The TwisterTM enables reversal of the blood lines without manually disconnected them to measure vascular access flow via the Krivitski Method®. The arterial and venous Flow/dilution Sensors are clamped between the TwisterTM and the red and blue caps on the lines that go to the patient’s access. All HD03 and all HD02 software versions 2.0.0 or higher do not require any repositioning of the Flow/dilution Sensors. Simply use the TwisterTM to reverse the bloodlines and take your vascular access measurement.

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Topics: VA Flow & Patency, Hemodialysis

How Access Flow can Impact Cardiac Output

Posted by Susan Eymann, MS on Dec 15, 2015 6:30:00 AM

Cardiovascular_HiRes.jpgAlthough extensively documented in the literature, the AV access is often overlooked as a source of cardiac dysfunction. By bypassing the customary arteriole/capillary beds and establishing a direct high flow connection between the arterial and venous systems, an AV access creates a drop in peripheral arterial resistance that significantly affects blood flow. In order to maintain blood pressure and improve cardiac output, the body compensates for this precipitous  drop in resistance by increasing heart rate and stroke volume.  This phenomena was first observed in World War II soldiers with trauma-induced arteriovenous fistulas. Iwashima et al reported an 15% increase in cardiac output by the seventh day after arteriovenous fistula creation1. This increased cardiac workload can lead to an increase in size of the left ventricle (left ventricular hypertrophy).

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Topics: Cardiac Function during Dialysis, VA Flow & Patency, Hemodialysis

8 Reasons to Perform Vascular Access Surveillance

Posted by Susan Eymann, MS on Dec 8, 2015 6:30:00 AM

Transonic ’s gold standard Hemodialysis Monitor is used to trend vascular access flow to assess vascular access patency. Unlike other technologies that can only identify outflow stenoses in AV accesses, HD03 Monitor surveillance can detect a stenosis wherever it occurs within the vascular access circuit: inflow, outflow or between the needles in both fistulas or grafts.

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Topics: VA Flow & Patency, Hemodialysis

Hemodialysis Surveillance in Pediatrics

Posted by Susan Eymann, MS on Dec 2, 2015 7:00:00 AM

The most common access in children remains a central venous catheter (CVC) even though an arteriovenous fistula meets the criteria of delivering a flow rate needed for the dialysis prescription, has a long use life and a low rate of complications. Nationally, only 12.3% of pediatric patients have an AVF and 8.5% have an AVG. Chand et al reported that, from his experience in northern Ohio where AVF rates in pediatric patients are more than 80%, higher AVF rates can be established through a multi-disciplinary team approach that involves pediatric nephrologists, experienced hemodialysis nurses, vascular surgeons, interventional radiologists and recreational therapist/child life specialists.1

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Topics: VA Flow & Patency, Hemodialysis

Fistula First - Catheters Last: A CMS-sponsored Break-though Initiative

Posted by Susan Eymann, MS on Nov 17, 2015 8:30:00 AM

The success of the Centers for Medicare and Medicaid Services (CMS) Fistula First Break-through Initiative has transformed a hemodialysis access in the United States from a “graft-oriented culture” to a “fistula-oriented culture” in less than 10 years. When the Fistula First Initiative took off in 2005, The United States lagged far behind their European counterparts in utilizing a fistula as a vascular access of choice for appropriate hemodialysis patients. An arteriovenous fistula (AVF) is the optimal vascular access for hemodialysis because it is associated with longer survival, fewer infections, lower hospitalization rates, and reduced costs. Now more than 60% of American hemodialysis patients have AV fistulas. The Fistula First goal is to reach 68%.

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Topics: Catheter Adequacy, VA Flow & Patency, Hemodialysis

Four Ways Measuring Blood Flow Optimizes Hemodialysis Adequacy

Posted by Susan Eymann, MS on Nov 10, 2015 8:30:00 AM

Transonic ’s Gold Standard Hemodialysis optimizes dialysis adequacy by:

  1. Identifying a Discrepancy Between Pump Setting & Delivered Blood Flow as a result of:
    • Effects of negative pump pressure effects;
    • Condition of access;
    • Needle size & placement;
    • Kinked or occluded tubing;
    • Calibration of the dialysis machine;
    • Change in type of dialysis tubing,
    • Calibration of Flow/dilution Sensors.
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Topics: Catheter Adequacy, VA Flow & Patency, Dialysis Delivered Blood Flow, VA Recirculation, Hemodialysis

Is Surveillance Useful? A New Spanish RCT Confirms its Value

Posted by Susan Eymann, MS on Nov 3, 2015 8:30:00 AM

The value of vascular access surveillance has been widely debated over the past decade. Some studies attest to its usefulness for identifying stenoses. Others question its value. Although all vascular access clinical guidelines recommend monitoring and surveillance protocols to prevent vascular access thrombosis, randomized clinical trials (RCT) have failed to consistently demonstrate the benefits of flow-based surveillance. Thus, the controversy over the value of surveillance continues.

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Topics: VA Flow & Patency, Hemodialysis