AV Fistula/Grafts in Hemodialysis & Transit Time Flow Measurement

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Vascular access flow is the fundamental measurement to determine the effectiveness of hemodialysis. Before Transonic® Hemodialysis surveillance, this measurement did not exist. Dialysis care teams had to rely on surrogate measurements such as recirculation, a late indicator of access dysfunction. Transonic revolutionized hemodialysis with the recognized gold standard “Kriviski Method” that directly measures vascular access flow in fistulas and grafts.

KDOQI Guidelines (as well as European, Canadian and Australian) initiated access flow warning signs that signal need for further monitoring and possible corrective action. The first flow threshold is flow less than 600 mL/min for grafts and 400-500 mL/min for fistulas. Secondly, the Guidelines recommend flow trending to identify a failing access.

Vascular access measurements:

  1. Indicate effectiveness of interventions (post-intervention surveillance) or limb ischemia;
  2. Exclude access dysfunction quickly as cause of underdialysis;
  3. Identify a mid-access obstruction;
  4. Identify high-flow versus low flow accesses to select ideal treatment plan for correction (flow-restricting versus re-vascularization procedure);
  5. Permit access surveillance to be performed by the clinic’s staff who then can alert the nephrologist to the possible onset of access dysfunction;
  6. Implement KDOQI Guidelines with Gold Standard reference method.

Best Practice: Flow-based surveillance per KDOQI Guidelines alerts a patient care team to patients at risk for underdialysis, thrombotic events and cardiac failure.