Comparison Between Two On-Line Reversed Line Position Hemodialysis Vascular Access Flow Measurement Techniques: Saline Dilution and Thermodilution

Abstract

Periodical access flow measurements can predict the development and presence of vascular access flow-limiting stenosis and subsequent thrombosis. Access flow measurement has become a standard in vascular access care. Different techniques to measure access flow are available. The aim of this study was to compare an integrated access flow measurement device, based on thermodilution (Blood Temperature Monitor, BTM, Fresenius Medical Care, Bad Homburg, Germany), with the gold standard, the HD01 (Transonic Systems Inc., Ithaca, NY), whose technique is based on saline dilution. In 40 patients with end-stage renal disease, 40 vascular accesses were studied to determine the correlation between access flow measurements by both techniques. Reproducibility of access flow measurements by both techniques was assessed in 20 patients on a weekly interval.A total of 40 measurement series were performed. Average access flow measured with the saline technique and the thermodilution technique was 1053 (+/-495) ml/min and 1034 (+/-527) ml/min, respectively (p = ns) (n = 40). Correlation between access flow measurements by both techniques expressed in R was 0.79 (r = 0.89). Reproducibility of saline and thermodilution subsequent measurements with a weekly interval, expressed in relative difference (Delta xrel) was 13 (+/-11)% and 24 (+/-14)%, respectively (p < 0.01) (n = 20).BTM access flow measurements correlated well with the HD01 access flow measurements. However, the better reproducibility of HD01 and shorter measurement time compared with BTM access flow measurements should be considered when implementing access flow measurement to prevent vascular access failure.

Comparison of Different Methods to Assess Fistula Flow

“…While different studies compared the available techniques [9,10,12,[14][15][16] , none of them investigated to which degree the prescribed recommendations for performing measurements should be followed. Therefore, besides the comparison of three AF measuring methods (based on US, BTM, and OCM), the present study investigated whether US and BTM measurements are influenced by the Q B applied, the time point of measurement, and the patient's position.…”

“…Two modules available on several hemodialysis machines, i.e. the blood temperature monitoring (BTM) [8][9][10] and online clearance monitoring (OCM) [11,12] , however, have also been used to calculate AF.…”

Practical Utility of On-Line Clearance and Blood Temperature Monitors as Noninvasive Techniques to Measure Hemodialysis Blood Access Flow

“…This indirect dilution method detects early fistula dysfunction by percentage of access recirculation with a diagnostic sensitivity of 81.8% and a specificity of 98.6% [29]. The mean values obtained with thermodilution in recent studies that included mostly patients with AVF were 1,034 ml/min and 1,170 ml/min with no significant difference with respect to the SDM and Delta-H methods, respectively [30,31]. In the present study, BTM-Qa showed better general accuracy and concordance than OLC-Qa compared with the ultrasonography method.…”

Stent Placement Versus Angioplasty Improves Patency of Arteriovenous Grafts and Blood Flow of Arteriovenous Fistulae

“…All referrals for intervention were based on standard Kidney Disease Outcomes Quality Initiative (KDOQI)/Fistula First published criteria, which may include one or a combination of the following: physical examination abnormalities, poor blood flows, elevated venous/arterial pressures, increased bleeding, inability to cannulate, decrease in Transonic HD02 Hemodialysis Monitor (Transonic Systems, Ithaca, NY) access flows, or decrease in dialysis adequacy measured by Kt/V or URR (25,26).…”

“…Patients had their access blood flow and URR measured by Transonic HD02 from day 1 to day 30 after intervention and then routinely as part of our access monitoring program once per month (25,26 …”