[Management of vascular access: monitoring and surveillance].
This article reviews vascular access (VA) assessment methods and procedures. It gives an overview of the existing methods for bed-side VA assessment by means of pressures, recirculation and access flow measurement. Pros and cons of the methods are discussed and additional benefits of a combined recirculation and access flow measurement are explained. Present vascular access care guidelines are discussed, namely the K/DOQI and EVAS documents. Practical setup of a vascular access monitoring and surveillance system is illustrated with data from the authors' own unit where such a system has been in use since 1999. The issue of adequate target setting is analysed in view of published works on clinical impact of access surveillance system introduction (timely detection of access stenosis and access patency). Critical re-evaluation is needed especially in current QVA threshold and intervention timing.
Lopot
F
F
Department of Medicine, General University Hospital, Prague--Strahov, Tschechische Republik. f.lopot@vfn.cz
Svára
F
F
Polakovic
V
V
D001166:Arteriovenous Shunt, Surgical / Q000451:nursing / Q000592:standards*; D001783:Blood Flow Velocity; D003365:Costs and Cost Analysis; D003627:Data Interpretation, Statistical; D006436:Hemodialysis Units, Hospital / Q000592:standards; D006801:Humans; D008954:Models, Biological; D008991:Monitoring, Physiologic / Q000191:economics / Q000379:methods*; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis / Q000295:instrumentation*