Vascular dialysis access flow measurement: early intervention through early detection.
OBJECTIVE
The aim of the project is to determine the effectiveness of using online access flow measurement, thermodilution method (Fresenius BTM), in detecting and predicting thrombosis or stenosis of the haemodialysis fistula, so that early intervention could be instituted.


METHODS
All haemodialysis patients with permanent vascular dialysis access, either arteriovenous fistula (AVF) or arteriovenous fistula graft (AVG), in a large tertiary referral Dialysis Service in Australia were included in this prospective observational quality project, conducted over 12 months.


RESULTS
Out of 165 patients studied, 36 patients were found to have poor dialysis access flow, defined as AVF--flow of <200 ml/min or a decrease of 25% from last measurement or AVG--flow of <600 ml/min or a decrease of 25% from last measurement. Doppler ultrasounds were performed, and confirmed findings of significant stenosis, either on the arterial or venous sites, as indicated by poor dialysis access flow results.


CONCLUSIONS
Thermodilution technique is a reliable and effective method of detecting poor dialysis access flow for patients with permanent vascular access, comparable with other techniques.
Miguel
Susana San
SS
Area Renal Service, Western Zone, Sydney South West Area Health Service, Sydney, Australia. Susana.Sanmiguel@sswahs.nsw.gov.au
Chow
Josephine
J
D017130:Angioplasty; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000451:nursing; D001315:Australia / Q000453:epidemiology; D001783:Blood Flow Velocity; D015400:Clinical Nursing Research; D003251:Constriction, Pathologic / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D003936:Diagnosis, Computer-Assisted / Q000379:methods; D042241:Early Diagnosis; D006083:Graft Occlusion, Vascular / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods / Q000451:nursing; D009730:Nursing Assessment; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation* / Q000451:nursing; D013815:Thermodilution / Q000379:methods*; D013927:Thrombosis / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D014654:Vascular Patency