Vascular Access Quality Monitoring

Lopot, František; Portová, M; Bednárová, Lucia; Pilbauerová, K; Wittgrúberová, M; Nejedlý, B

doi:10.1111/j.1755-6686.2003.tb00278.x

Cited by 3 publications

(3 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It must be noted that haemodynamic monitoring may differ according to the technology and methodology used [ 34 ]. However, ultrasound dilution appears to be a gold standard in comparison with others [ 35 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

Systemic haemodynamics in haemodialysis: intradialytic changes and prognostic significance

Haag¹,

Friedrich²,

Häring

et al. 2018

Nephrology Dialysis Transplantation

View full text Add to dashboard Cite

BackgroundAlthough haemodialysis (HD) leads to alterations of systemic haemodynamics that can be monitored using dilution methods, there is a lack of data on the diagnostic and prognostic significance of haemodynamic monitoring during routine HD.MethodsIn this multicentre study, we measured cardiac index (CI), access flow (AF) and central blood volume index (CBVI) during a single HD session in stable HD patients (n = 215) using the Transonic HD03 monitor (Transonic, Ithaca, NY, USA). Systemic CI (SCI) was defined as CI corrected for AF. In a subset of patients (n = 82), total end-diastolic volume index (TEDVI) and total ejection fraction (TEF) were derived from dilution curves. Data were correlated with clinical parameters, cardiac biomarkers and bioimpedance measurements (body composition monitor; Fresenius Medical Care, Homburg, Germany). Mortality was assessed prospectively after a median follow-up of 2.6 years.ResultsMedian CI, CBVI and AF were 2.8 L/min/m2 (interquartile range 2.4–3.4), 15 mL/kg (14.5–15.7) and 980 mL/min (740–1415), respectively, at the beginning of HD. At the end of HD, CI, CBVI and AF significantly fell by −10% (−22 to 3, P < 0.0001), −9% (−23 to 3, P < 0.0001) and −4% (−13 to 5, P = 0.0004), respectively. Peripheral resistance (PR) increased slightly (P = 0.01) and blood pressure fell by −6/−3 mmHg to 128/63 mmHg (P < 0.0001). Independent predictors of ΔCI were age and ultrafiltration rate, whereas AF, overhydration and PR were protective. TEF was strongly associated with mortality [area under the dilution curve 0.77, P < 0.0001], followed by TEDVI (0.72, P = 0.0002) and SCI (0.60, P = 0.02).ConclusionsHD leads to a reduction of CI due to ultrafiltration. Haemodynamic monitoring identifies a significant number of HD patients with cardiac impairment that are at risk for increased mortality.

show abstract

Section: Discussionmentioning

confidence: 99%

Systemic haemodynamics in haemodialysis: intradialytic changes and prognostic significance

Haag¹,

Friedrich²,

Häring

et al. 2018

Nephrology Dialysis Transplantation

View full text Add to dashboard Cite

show abstract

“…Three modes of the optodilutional/optoconcentrational principle are used in the Crit-line instrument (Hemametrics, Riverdale, Calif., USA) known rather for its use in continuous blood volume monitoring by measurement of hematocrit in a cuvette inserted into the extracorporeal circuit at the dialyzer inlet [19] . The dilutional effect is induced either by injecting 10 ml of saline (fi rst in the venous blood line and then in the arterial line) in recircu- lation measurement mode (R mode) or by a stepwise change in the UFR in access fl ow measurement mode (ABF).…”

Section: Optodilution/optoconcentrationmentioning

confidence: 99%

Vascular Access Monitoring: Methods and Procedures – Something to Standardize?

Lopot

Nejedlý

Válek³

2005

Blood Purif

View full text Add to dashboard Cite

The article discusses the issue of suitable parameters (pressures, recirculation and access flow) to assess hemodialysis vascular access quality (VAQ), available methods to measure those parameters and the setup of the entire VAQ surveillance system (VAQS) in a dialysis facility. Special attention is paid to factors which need some standardization to enable evaluation of VAQ trends in an individual as well as comparison of data from different patients and different dialysis facilities. The discussed procedures are documented with the authors’ own measurement results and the results of the VAQS implemented in their unit. Both dynamic and static pressures exhibit insufficient sensitivity in detecting stenoses in native arteriovenous fistulas. Access recirculation is a late finding because with its non-zero value dialysis quality is already compromised. Timely and reliable detection of a deteriorating access condition is enabled by access flow (QVA) only. No standardization is needed in extracorporeal blood flow used in QVA evaluation by ultrasonic dilution. Multiple measurements may increase the reliability of thermodilutional measurements and are a must in optodilutional ones. Timing of the measurement during dialysis should be standardized. Measurement frequency should take into account access type, QVA value and access history. Shortened intervals are needed in the immediate post-intervention period with regard to risk of re-stenosis incidence and strongly nonlinear QVA decreases in such cases. A significant shift-over from surgical interventions to balloon angioplasties is to be expected with the introduction of a VAQS, and appropriate measures must be taken to ensure their quick availability.

show abstract

“…Typically, thermodilutional measurement, using the simple Krivitski formula, 15 progressively underestimate QVA values from 700 to 800 ml/min up compared to ultrasonic dilution. 16 Unfortunately, there are just a few works which provide wider comparison. 17,18 Table 6 shows variation coefficient (VC) of the most commonly used methods we found in one of our VA studies.…”

Section: Patient Cohort and Surveillance Methods Usedmentioning

confidence: 99%

Changes in vascular access blood flow: Etiological factors and clinical implications

et al. 2020

View full text Add to dashboard Cite

Changes in access blood flow (QVA) are of utmost importance in vascular access (VA) management when deciding on VA referral for an intervention. The article elucidates impact of different factors on QVA changes. Methods: Records of 10,000 QVA measurement performed in 549 patients over 20 years were used as retrospective and anonymized data source, making ethical commission involvement unnecessary. Two approaches are used to elucidate association of QVA changes with different factors: analyses of smaller cohorts in which both the QVA and the respective factor were measured (e.g. association of QVA with cardiac output (CO)), or—in case of rare phenomena—a form of a well illustrated case reports was used (e.g. association of QVA and Kt/V). Results: Significant increase in CO after permanent VA creation (3-4-fold of the QVA value) was found. Impact of intradialytic CO changes on QVA is attenuated by relatively stable VA resistance compared to systemic resistance. Blood pressure impact is much stronger and it should therefore be noted at each QVA measurement. As reproducibility of different QVA measurement methods varies, use of the same method should be preferred. Direction of the arterial needle insertion in VA affects the QVA measured, especially in synthetic grafts, too. Also patient’s own QVA variability may be quite high. All this makes KDOQI/EBPG recommended acceptable QVA drops too strict, they should be revised. In re-stenoses prone patients, measurement intervals should be shortened, too. Conclusion: QVA values are significantly affected by many factors. Their knowledge appears essential for safe and effective VA surveillance and management.

show abstract

Vascular Access Quality Monitoring

Cited by 3 publications

References 20 publications

Systemic haemodynamics in haemodialysis: intradialytic changes and prognostic significance

Systemic haemodynamics in haemodialysis: intradialytic changes and prognostic significance

Vascular Access Monitoring: Methods and Procedures – Something to Standardize?

Changes in vascular access blood flow: Etiological factors and clinical implications

Contact Info

Product

Resources

About