McCarley, P., Wingard, R.L., Shyr, W., Pettus, W., Hakim, R.M., Ikizler, T.A., "Vascular Access
Blood Flow Monitoring Reduces Access Morbidity and Costs," Kidney International 2001; 60:1164-1172. |
The September 2001 edition of Kidney International published "Vascular access blood flow monitoring reduces access morbidity
and costs", an analysis of a three-phase study comparing the clinical and financial impact of access blood flow monitoring with the Transonic HD01 to detect access malfunction. A research team of Vanderbilt University
Medical Center, Dialysis Clinics, Inc., and Renal Care Group, Inc. staff investigated the effect vascular access blood flow monitoring (VABFM) on thrombosis-related events, compared to the effect of dynamic venous
pressure monitoring (DVPM), and that of no monitoring for vascular access stenosis. McCarley et al. state that vascular access morbidity results in poor patient outcomes and accounts for approximately fifteen percent of
total annual Medicare expenditures for ESRD. 
Study
The authors collected access-related information for one hundred thirty-two chronic hemodialysis patients over a three-phase study (Phase I, eleven months no monitoring,
Phase II, twelve months DVPM, Phase III, ten months VABFM). The patient population included hemodialysis patients treated three times per week with either an A-V graft or fistula. Three
patient-care technicians, supervised by the facility manager, were trained to perform monitoring tests in addition to their routine duties. During Phase II of the study, the dialysis staff monitored dynamic venous
pressure at a pump flow of 200 ml/min in the first five minutes of dialysis, as prescribed by the NKF-DOQI Guidelines. In Phase III, VABFM followed the protocol shown in the diagram. (Insert
diagram) When VABFM and DVPM potential vascular access failure, the patient was referred for a fistulagram with percutaneous angioplasty (PTA) or surgery following within one week. Results
The graft thrombosis rate decreased from 0.71 in Phase I, to 0.67 in Phase II, to 0.16 per patient per year in Phase III. PTA procedures increased
from 0.09, to 0.32, to 0.54 per patient per year, in Phases I, II, and III, respectively. Hospital days related to vascular access morbidity decreased during the study from 1.8 in
Phase I, to 1.6 in Phase II, and 0.4 per patient per year in Phase III, while missed dialysis treatments also fell from 0.98 in Phase I, to 0.86 in Phase II, to 0.26 per patient per year
in Phase III. Similarly, catheter use declined from 0.29 placements in Phase I, to 0.17 placements in Phase II, to 0.07 placements per patient per year in Phase III. Conclusion
As a result of reduced vascular access morbidity, related costs fell forty-nine percent from Phase I with no monitoring to Phase III with VABFM and were fifty-four percent less
in Phase III than in Phase II, effecting a total savings of $158,550. McCarley et al. conclude that "vascular access blood flow monitoring along with preventative
interventions should be the standard of care in chronic hemodialysis patients". |
