Tracking Arteriovenous Fistula Maturation: A Novel Approach

Abstract

Background: The time between the creation of an arteriovenous fistula (AVF) and its successful use is significantly longer in hemodialysis (HD) patients in the United States compared to those in other countries, and there is an urgent need to reduce the residence time of central-venous catheters (CVC). Methods: Successful AVF creation and maturation results in typical hemodynamic changes, such as an increase in cardiac output and upper body blood flow (UBBF). In patients with CVC as vascular access, we measured once per minute intradialytic central-venous oxygen saturation (ScvO₂) and hemoglobin levels simultaneously using the Crit-Line Monitor. Under conditions of stable upper body oxygen consumption and arterial oxygen saturation, ScvO₂ and hemoglobin concentration allows the calculation of estimated UBBF (eUBBF). In a quality improvement project, we used ScvO₂ and eUBBF to track the hemodynamic changes accompanying AVF maturation. Results: Out of 11 patients (9 incident to HD, 1 female, age 61 ± 13 years), AVF maturation was successful in 9. In 1 patient, the AVF did not mature. One patient died from sudden cardiac death with a maturing AVF. In the 9 patients with successful AVF maturation, ScvO₂ increased from 60.9 ± 2.7% prior to AVF creation to 73.4 ± 3.6% a week after AVF creation (19.6 ± 6.3% increase). eUBBF increased from 1.3 ± 0.3 to 2.2 ± 0.6 L/min (62.7 ± 37.5% increase); no material ScvO₂ or eUBBF changes occurred in the other 2 patients. Conclusion: Our results indicate the potential utility of ScvO₂ and eUBBF to track the hemodynamic response to AVF maturation. To what extent these insights translate into shortening of the time between AVF creation and successful cannulation warrants further investigations.

Impacts of continuous quality improvement on wound pain in the puncture site of arteriovenous fistula in haemodialysis patient

“…Compared to arteriovenous grafts and long‐term dialysis catheters, AVFs are preferred due to their low infection rate, simplicity, repeatability and stable blood flow and are recognized globally as the optimal long‐term vascular access. 20 , 21 While extending patients' lives, HD also imposes a considerable symptomatic burden, with pain being a common issue. The incidence of pain in HD patients ranges from 21% to 92% and is associated with their mortality rate.…”

The time of onset of intradialytic hypotension during a hemodialysis session associates with clinical parameters and mortality

“… 18 Further details on the assumptions underlying this formula can be found in previous work from this group. 19 …”

“…18 Further details on the assumptions underlying this formula can be found in previous work from this group. 19 To account for the fact that UFR can vary during a session, particularly in a session where IDH occurs, we defined the UFR for a given session as the mean of all recorded UFRs preceding an IDH episode, where an episode occurred, and the mean of all recorded UFRs in a session where it did not. UFR was normalized to postdialysis body weight and reported as ml/hour per kg.…”

Monitoring the Patient Following Radio-Cephalic Arteriovenous Fistula Creation: Current Perspectives

“…Rosales and colleagues measured central venous oxygen saturation (ScvO2) levels in HD CVC-carrying patient's candidates for AVF surgery. 64 In patients with successful AVF maturation, ScvO2 increased by 20% one week after the creation of the access. No increase occurred in patients where AVF maturation failure occurred.…”