Best Practice:

Ensure adequate dose delivery by direct accurate measurement of pump blood flow and access recirculation in AV accesses and catheters with Transonic flow surveillance.

Pump (delivered blood) flow errors and recirculation compromise dialysis dose delivery. The Transonic Flow-QC® Monitor offers the opportunity to monitor both delivered blood flow and recirculation during routine hemodialysis.

KDOQI Guidelines

“Any access recirculation is abnormal. Recirculation … should have prompt investigation of its cause. … If access recirculation values exceed 20%, correct placement of needles should be confirmed before conducting further studies.”¹

Delivered Blood Flow-QC^®

Assures delivery of prescribed dialysis dose!

Transonic Flow-QC^® Monitors measure true delivered blood flow through dialysis tubing using Gold Standard Transit-time Ultrasound Technology, the only technology that can directly measure flow. By comparing actual delivered blood flow to the pump’s reading, any flow disparity between the two can be identified, investigated and corrected.^2,3 Delivered Blood Flow-QC^® is used to:

• Test blood pump calibration and its “effective flow” algorithm;
• Find the cause of excessive negative arterial pressure;
• Determine the most appropriate blood pump setting for a low flow access when it is not feasible to increase access flow.⁴
• Diagnose tubing set flow restrictions, a cause of hemolysis. 

AV Access Recirculation Flow-QC^®

Assures delivery of prescribed dialysis dose!

With a single infusion of saline, the Flow-QC^® Monitor will detect and quantify access recirculation, a late indicator of a failing access. Transonic Ultrasound Dilution Technology is the only technology that is able to separate actual cardiovascular recirculation form cardiopulmonary recirculation. Thus, Zero Percent Recirculation, a new standard, can be quantified.^5.6 

Recirculation Flow-QC® [measurements] will:

• Identify inadvertent reversal of blood lines;
• Confirm proper needle placement.
• Confirm 0% recirculation

Catheter Flow-QC^® 

Assures delivery of prescribed dialysis dose!

Central venous catheters often underdeliver dialysis due to: a discrepancy between a pump’s setting and its actual delivered flow and/or the presence of recirculation. Transonic Flow-QC^® is the only technology able to optimize catheter dialysis delivery by:⁷

• Establishing a maximum dialysis pump setting before recirculation occurs;
• Using known values for flow and recirculation to adjust the length of dialysis;
• Identifying flow restrictions and finding the best connections between a catheter and blood lines.

References

1. KDOQI Guidelines for Vascular Access - Guideline 12
2. Depner, TA et al, “Pressure Effects on Roller Pump Blood Flow during Hemodialysis,” ASAIO Trans 1990; 31: M-456-M459.
3. Sands, JJ et al,“Difference between Delivered and Prescribed Blood Flow (QB) in Hemodialysis,” ASAIO J 1996; 42(5): M717-719. 
4. Spergel, LM,“Transonic Flow Surveillance — The Cornerstone of My Vascular Access Management Program (VAMP©),” Transonic Focus Note #HD58.
5. MacDonald et al, “Identifying A New Reality: Zero Vascular Access Recirculation Using Ultrasound Dilution,” ANNA J 1996; 23(6): 603-608.
6. Alloatti, S et al, “Measurement of Vascular Access  Recirculation Unaffected by Cardio-pulmonary Recirculation: Evaluation of an Ultrasound Method,” Nephron 1999; 81:25-30.
7. Kelber, J et al, "Factors Affecting Delivery of High-Efficiency Dialysis Using Temporary Vascular Access,” Am J Kid Dis 1993; 22(1): 24-29.

Dialysis Adequacy Publication Reference Lists:

Zero Vascular Access Recirculation - A New Reality

Discrepancy between Prescribed and Delivered Pump Flow (Qb) in the Vascular Access

Catheters (Recirculation and Delivered Flow)