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Vascular Access Management

FlowQC

Non-Invasive - On-the-spot - Immediate Results

 

 

"Reductions in flow lead to subtle often unrecognized compromises in delivery of dialysis and presage failure of the access device itself. Access flow can therefore be considered a fundamental property of the access that should be monitored."
Depner, TA et al, ASAIO J 41:745-749, 1995

Vascular Access Surveillance Protocol
Proactive Vascular Access Management

The Transonic Hemodialysis Flow-QC Monitor gives you the opportunity to screen your patient's access during routine dialysis. You get an instant snapshot of access flow and can build a record of its patency. A drop in access flow is your signal that a stenosis is forming. Such routine access flow screening has been, up to now, both costly and impractical. While color Doppler ultrasound scans visualize stenoses, they do not quantify turbulent flow levels. Furthermore, for routine screening purposes they are prohibitively expensive.

    Actual access flow rate is measured upon complete mixing of indicator with blood while the dialysis lines are reversed. Vascular access flow is displayed on the screen in ml/min.

    • simple procedure with physiological saline
    • detects reduction in access flow to identify problems at an early stage
    • allows differentiation between needle placement and access insufficiency as cause of recirculation
    • can be repeated routinely
    • "We now can spot problems before the access clots giving us more time to examine the patient, investigate the access, and decide on a treatment plan." Kapoian, T., Dialysis Clinic Inc., Rbt. Wood Johnson Dialysis Ctr.

    If your clinic mirrors the USA national average, 15-20% of your patients have access flow levels so low that a full revision surgery will be necessary to maintain dialysis. Other patients are more fortunate: there is irrefutable evidence (Schwab, '89, Sands,'92,'95; Besarab,'93,'95) that the functional life of an access can be extended via minimally invasive procedures like angioplasty, when the onset of a stenosis is diagnosed. Monitoring access flow lets you do just that.

    " ...elective correction of abnormalities in PTFE grafts and in AV fistulas prolongs access life (330 days per graft, 641 per fistula) when compared to repair after an initial episode of clotting." Sands, JJ et al, Clinical Nephrology 44(2):329-333, 1995

 

 

stenosisgraph

Case Report: Vascular Access Stenosis Identified - Recirculation
During a routine screening, a 56-year-old male patient with an upper arm fistula exhibited 37% recirculation at a Qb of 333 ml/min. When his corresponding access flow was 286 ml/min, a significant access stenosis was suspected. The stenosis was confirmed by color Doppler and was subsequently corrected by angioplasty.

Case Report: Stenosis between Needles Identified - No Recirculation
A 41-year-old ESRD patient with a lower arm A/V fistula exhibited no recirculation at a Qb of 323 ml/min. However, when vascular access flow was measured, it was only 118 ml/min, significantly less than Qb. A suspected stenosis between the hemodialysis needles was confirmed by color Doppler ultrasound and was corrected.

 

 

graph

 

 
References: Vascular Access Patency

A. Methodology and Validations of Access Flow Measurement by Krivistki Method

Predictive Power of Access Flow Measurements

Transonic Flow-QC - A New Standard of Care for your hemodialysis patients.

 

 
 
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