Transonic Hemodialysis Flow-QC^® News

The Global Newsletter from The Flow Measurement Specialists

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The Global Newsletter from The Flow Measurement Specialists

Dear Dialysis Specialist,

This month’s newsletter reports on the development of Hemodialysis around the world and customer service issues relating to your system.

Upcoming Events

• USA
• International

In Focus

• Measuring Vascular Access Flow in AV Fistulas
• Vascular Access Society’s Clinical Algorithms
• The Renal Association

Transonic Flow-QC^® in Recent Publications

• Elevated Static Intra-Access Pressure Ratio is not Indicative of Low Access Blood Flow ->Go
• Arteriovenous Fistula-Associated High-Output Cardiac Failure: a Review of Mechanisms ->Go

   Frequently Asked Questions

• Can you inject saline into the injection port of the Flow-QC tubing set to conduct recirculation or access flow measurements? ->Go
• Can you accurately measure cardiac output when recirculation is >0? ->Go
• Can I conduct multiple access flow measurements on the same patient in the same session? ->Go

Customer Service

• HD02 Troubleshooting Case
• Important Note on Yearly Calibration of HD Systems
• HD02 Software Tip
   

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Upcoming events

USA     February 28 - March 2, 2005 Annual Dialysis Conference (ADC) Tampa, FL April 18-21, 2005 American Nephrology Nurses Association (ANNA) Las Vegas, NV International     November 18-21, 2004 CANNT/ACITN 2004 Niagara Falls Ontario

In Focus

Measuring Vascular Access Flow in AV Fistulas

Measuring Vascular Access Flow in AV Fistulas - Higher flow rates, superior patency, and low incidence of infections make arteriovenous fistulas the vascular access of choice when compared to arteriovenous grafts or catheters. ..More

Vascular Access Society’s Clinical Algorithms

The Vascular Access Society located in The Netherlands has Clinical Algorithms on Vascular Access for Hemodialysis. Under the Identification of A/V Fistula and Graft Problems section, the Society lists guidelines for vascular access flow. The guideline states:

Progressive stenosis due to intimal hyperplasia, usually at the site of the A/V anastomosis in native A/V fistulas and venous anastomosis in grafts, jeopardizes the blood flow with subsequent thrombotic occlusion. Therefore, it seems clear, that there is need to follow A/V fistulas and grafts in a standardized surveillance program with special emphasis on vascular access flow (Qa) measurements. Several studies stress the importance of non-invasive or in-line flow measurements and correlate these with the outcome of native A/V fistulas and grafts.

The Renal Association

The Renal Association is the professional body for United Kingdom nephrologists (renal physicians, or kidney doctors) and renal scientists in the UK. It is active in the planning and development of renal services and nephrology in Britain. It is also involved in the promotion and dissemination of research and education relating to the specialty. The Association was founded in 1950, when its activities were restricted to holding scientific meetings. It has more recently come to play an active role in the development of renal services within the U.K.
 

Transonic Flow-QC^® in Recent Publications

Elevated Static Intra-Access Pressure Ratio (IAPR) Is not Indicative of Low Access Blood Flow (AF)

Lawrence M Spergel, MD, from the Dialysis Management Medical Group in San Francisco,  performed a study to investigate the premise that elevated IAPR (Intra-Access Pressure Ratio) is indicative of low AF (Access Flow).  IAPR and AF were measured simultaneously over an 8-month period in 243 patients from 3 centers. AF was measured by ultrasound dilution with equipment from Transonic Systems Inc.  The revealed no correlation between AF and IAPR. ..Abstract

Arteriovenous fistula-associated high-output cardiac failure: a review of mechanisms.

A recent publication in the May 2004 issue of the American Journal of Kidney Diseases by Jennifer MacRae MSc, MD, describes an interesting Case report of a 65-year-old patient on intermittent dialysis since 1997 who developed an enlarged heart along with an elevated cardiac output (7.5 L/min) measured by ultrasound dilution technology. Ligation of the AV fistula followed ..Abstract
 

Frequently Asked Questions

Can you inject saline into the injection port of the Flow-QC tubing set to conduct recirculation or access flow measurements?

No. You need to either release the saline directly from the saline bag or inject 10ml of saline before or into the venous bubble trap. Likewise, you need to inject 30 ml of warmed saline into injection port of the Flow-QC tubing for cardiac output measurements.

Can you accurately measure cardiac output when recirculation is >0?

No. Any real access recirculation will prevent an accurate cardiac output measurement. During a cardiac output measurement, the HD02 system will recognize that recirculation is present and display the message “Check for recirculation, reduce Qb”.

Can I conduct multiple access flow measurements on the same patient in the same session?

Yes. As long as the traffic light is green, you can conduct measurements. There is no verbal message that reminds you the system is ready to take another measurement.
 

Customer Service

HD02 Troubleshooting Case A nurse from a dialysis clinic called with questions about some HD02 measurements on a particular patient. She explained the situation as this: In Normal line Position: Dialysis Machine Pump Flow = 400 ml/min, Delivered Flow by HD02 = 160 ml/min and Access Recirculation = 0%.  In Reversed Line Position: Dialysis Machine Pump Flow = 300 ml/min, Delivered Flow by HD02 = 160 ml/min and Two Access Flow Measurements = 1800 ml/min and 2000 ml/min.  Question 1: What was the delivered flow reading on previous patient? Qb by HD02 and HD machine corresponds within 10%.  Question 2: What was the access flow reading on this patient the previous month? 2000 ml/min at Qb = 300ml/min. Possible Solution: Check blood line kinking.  Response: Yes, bloodline was kinked near dialyzer.  Message: Check bloodline tubing for occlusion when there is large discrepancy between pump flow and delivered flow. Believe in the HD02 measurements! Important Note on Yearly Calibration of HD Systems It is important to send HD systems in for a yearly calibration. This will certify the accuracy of the system and allow reproducibility of the measurements. A calibration reminder is built into the HD02 software.  Under MDD law, calibration must be done by someone certified to do this. Transonic is the only firm which can perform such certifications. HD02 Software Tip When there is “No Recent Measurement Detected” Whenever the traffic light turns green, the software will detect any idle use of the program for 10 minutes. During the last minute, an on-screen countdown will start. The options are Continue with Current Patient or Stop Patient Session. If neither option is selected, the patient session will stop automatically after the 60 second countdown. Since the HD02 software is always recording waveforms to disk when in a patient session, this feature is a precaution to prevent filling up the hard disk with essentially no data. It also prevents the user from accidentally testing another patient in the same session.

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We invite your comments, questions and suggestions and hope that “Transonic Surgical/ICU Flow-QC® News” will become a forum for passing on your success stories, providing answers to some of your frustrations.  If you have a new technique you’d like to share or a problem you need help with, please feel free to contact us.