Vascular access quality monitoring.
Access dysfunction presents a risk for haemodialysis patients and is costly for health care providers. Regular vascular access quality (VAQ) monitoring enables the detection of adverse access conditions early allowing timely interventions, which will presumably be less invasive, more successful and cheaper. This paper reviews all currently used assessment parameters: dynamic and static pressures, recirculation and blood flow through the access--and analyses pros and cons of each of them. Based on this overview it is concluded that access flow monitoring should be the method of choice, possibly combined with monitoring of another parameter to further enlarge diagnostic possibilities of the monitoring. The VAQ monitoring system developed and used currently in the author's dialysis centre is briefly described as an example. The issue of access flow related to haemodynamics is briefly mentioned. With the introduction of any VAQ monitoring system, one has to acknowledge a change in structure of interventions and that the demand for surgical procedures decreases with a concurrent increase in percutaneous interventions.
General University Hospital, Department of Medicine, Prague, Strahov, Czech Republic. f.lopot@vfn.cz
F
F
Lopot
M
M
Portová
L
L
Bednárová
K
K
Pilbauerová
M
M
Wittgrúberová
B
B
Nejedlý
D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000592:standards*; D001783:Blood Flow Velocity; D001794:Blood Pressure; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000592:standards*; D004868:Equipment Failure; D006083:Graft Occlusion, Vascular; D006301:Health Services Needs and Demand; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008991:Monitoring, Physiologic / Q000379:methods* / Q000592:standards; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000592:standards; D019984:Quality Indicators, Health Care; D006435:Renal Dialysis / Q000295:instrumentation* / Q000592:standards; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors