Transonic Measurements Are Essential Tools in a Nephrologist’s Toolkit
By Susan Eymann, MS15 Jul 2020
The new 2019 KDOQI Guidelines were recently released and Transonic applauds the committee for its diligence and guidance that every hemodialysis treatment option be customized to the individual hemodialysis patient.
As a long-time vascular access flow measurement surveillance provider and expert on vascular access flow, the dialysis community has often reached out to Transonic for feedback to on vascular access surveillance and flow. Before our entrance into the Hemodialysis market, Transonic had already earned a reputation as the gold standard measurement for highly accurate tubing flow measurements and blood vessel flow measurements during surgical procedures.
Transonic was then asked by leading nephrologists such as Dr. Thomas Depner to provide quantitative access flow data to support a nephrologist’s clinical decision making. In a brilliant moment of inspiration, Transonic’s Dr. Nikolai Krivitski envisioned a method of combining transit-time ultrasound flow technology and indicator dilution technology to enable a novel, non-invasive flow measurement of the actual volume flow in mLs/min that is flowing through the vascular access itself. This measurement, trended over time, allowed nephrologists their first inside peek ever into what the true flow was within an access. By giving hemodialysis staff an actual measure of vascular access flow, this new tool revolutionized hemodialysis. However, how this novel measurement should be integrated into a hemodialysis protocol was and continues to be a topic of discussion and debate, as evidenced in the recent KDOQI revisions.
Can Transonic measurements be the only information in a nephrologists toolkit? Can an access flow measurement be used as a spot measurement? Can their use help determine long term vessel patency? No! These are not intended uses for Transonic Monitor’s flow measurements. Rather:
· Transonic Access Flow Measurements and Trends provide data over time to indicate flow-limiting conditions that can then be followed up on by the dialysis care team.
· Transonic Access Flow Measurements can also be used, post intervention, to confirm that those interventions actually produced the change intended.
· Transonic Delivered Flow and Recirculation Dialysis Adequacy Measurements help optimize treatment on the spot.
· Transonic Cardiac Output measurements warn of impending cardiovascular collapse and prompt the dialysis care team to investigate further.
Transonic’s position has always been to use its Hemodialysis Monitor measurements in conjunction with a nephrologist’s full clinical judgement and additional clinical inputs, such as physical exams and other tests. Indeed, when Transonic measurements show declining access flow over time, the immediate follow up is to bring that data to the nephrologist so that it can be followed up with additional testing and feedback.