Correction of discrepancy between prescribed and actual blood flow rates in chronic hemodialysis patients with use of larger gauge needles

2002 ◽  
Vol 39 (6) ◽  
pp. 1231-1235 ◽  
Author(s):  
Hitesh K. Mehta ◽  
Diane Deabreu ◽  
James G. McDougall ◽  
Marc B. Goldstein
Keyword(s):  
Blood Flow ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Flow Rates

Predicting arterio-venous fistula failure by urea–method derived access blood flow in chronic hemodialysis patients

2020 ◽  
Vol 21 (6) ◽  
pp. 1011-1016
Author(s):  
Kumtorn Lelamali ◽  
Piyarek Papirachanat ◽  
Thitiya Puavilai
Keyword(s):  
Blood Flow ◽  
Characteristic Curve ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Interquartile Range ◽  
Dialysis Access ◽  
Ultrasound Dilution ◽  
Limb Edema ◽  
Venous Fistula ◽  
Urea Method

Background: Dialysis access is an essential part of hemodialysis. Determining the access blood flow (Qa) can help predict arterio-venous fistula thrombosis. Qa determination by the urea method, which was previously described in the past is simple and is available in most of the dialysis units but was not be able to predict arterio-venous fistula thrombosis. Aim: To compare the efficacy of Qa determination by the urea method and by ultrasound dilution methods in predicting arterio-venous fistula failure. Methods: Qa was measured by urea method and by ultrasound dilution simultaneously, every 3 months for a period of 1 year, in stable chronic hemodialysis patients with arterio-venous fistula. Arterio-venous fistula failure determined by clinical parameters and confirmed by Doppler ultrasound before sending the patient for interventional angioplasty. Results: This study enrolled a total of 16 patients, with 63% being male, 75% with lower-arm arterio-venous fistula and around 43% with previously done angioplasty. 59-Qa measurements were done, and 6 patients underwent angioplasty (one patient for severe upper limb edema, one for access thrombosis, and four for access dysfunction). Qa determination by the urea method had non-significantly lower Qa, (745 mL/min (interquartile range: 509–1143) and 779 mL/min (interquartile range: 530–1160), (p = 0.58)) and high correlation (r = 0.83, p < 0.001) to Qa by ultrasound dilution. The cut-off criteria with its sensitivity and specificity in predicting the access failure were 440 mL/min, 66.67%, and 96.15% for Qa determination by the urea and 400 mL/min, 66.67% and 90.38% for Qa by ultrasound dilution, respectively, with no difference in the area under the receiver operating characteristic curve. Conclusion: Measurement of Qa determination by the urea method is well correlated with Qa by ultrasound dilution and can be used to predict vascular access failure.

scholarly journals A study of the finger blood flow in chronic hemodialysis patients.

1989 ◽  
Vol 37 (4) ◽  
pp. 1519-1522
Author(s):  
Kazunori Matsushita ◽  
Toshiyuki Tsuruta ◽  
Ryuji Kitajima ◽  
Toshinori Nakao ◽  
Tomoyuki Honda ◽  
...  
Keyword(s):  
Blood Flow ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Finger Blood Flow

Prescribing Dialysate Bicarbonate Concentrations for Hemodialysis Patients

1988 ◽  
Vol 11 (1) ◽  
pp. 45-50 ◽  
Author(s):  
F.G. Heineken ◽  
M. Brady-Smith ◽  
J. Haynie ◽  
J.C. Van Stone
Keyword(s):  
Blood Flow ◽  
Blood Flow Rate ◽  
Baseline Period ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Bicarbonate Concentration ◽  
Acid Base ◽  
Ultrafiltration Rate ◽  
Plasma Bicarbonate ◽  
Normal Acid

A rearranged equation of Sargent and Gotch (1) was used to determine dialysate bicarbonate concentrations for hemodialysis patients. Parameters in this equation include an estimate of the acid generated by each patient between treatments, an estimate for the dialyzer dialysance for bicarbonate, ultrafiltration rate, blood flow rate and a targeted mid-dialysis plasma bicarbonate concentration of 25 mEq/L. Nine patients were studied over a 35 week period to verify this method of determining each patient's dialysate bicarbonate concentration. Prescribed dialysate bicarbonate concentrations for the nine patients varied from 29 to 38 mEq/L with five patients having a prescribed value of 35 mEq/L. After a baseline period of five weeks, five patients switched from a 37 mEq/L acetate dialysate to their prescribed dialysate bicarbonate concentration. Four patients who had already been on bicarbonate dialysis at a concentration of 35 mEq/L were dialyzed with their prescribed dialysate bicarbonate concentrations. Patients were then followed for a study period of 30 weeks. The prescribed dialysate bicarbonate concentration resulted in more normal acid/base chemistries for both groups of patients. The results also demonstrate that chronic hemodialysis patients require individualization of dialysate bicarbonate concentrations.

scholarly journals Relation between Access Blood Flow and Mortality in Chronic Hemodialysis Patients

2008 ◽  
Vol 3 (2) ◽  
pp. 387-391 ◽  
Author(s):  
Mohammed Al-Ghonaim ◽  
Braden J. Manns ◽  
David J. Hirsch ◽  
Zhiwei Gao ◽  
Marcello Tonelli
Keyword(s):  
Blood Flow ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis

scholarly journals Manual Individualization of the Dialysate flow according to blood flow: Effects on the Hemodialysis dose delivered and on Dialysate consumption

2020 ◽  
Author(s):  
FAYE Moustapha ◽  
Niakhaleen KEITA ◽  
Maria Faye ◽  
Yousseph BERDAI ◽  
Ahmed Tall LEMRABOTT ◽  
...  
Keyword(s):  
Blood Flow ◽  
Flow Rate ◽  
Blood Flow Rate ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Dialysis Dose ◽  
Dialysate Flow ◽  
Dialysate Flow Rate ◽  
Flow Effects ◽  
The Impact

Abstract Background: The objective of this work was to assess the impact of the decrease in dialysate flow rate on the dialysis dose delivered (spKt /V) to chronic hemodialysis patients and to estimate the resulting water saving. Methods: It was a prospective 4-week-period study that included chronic hemodialysis patients with clinical and hemodynamic stability. The patients successively underwent hemodialysis with a dialysate flow rate of 500 ml / min, at 1, 1.2 and 1.5 times the blood flow rate. Each dialysate flow rate was applied for one week. During these 4 weeks, the following parameters were kept constant: duration of dialysis, blood flow rate, anticoagulation, membrane nature and surface. Results: Forty-five chronic hemodialysis patients were included with a mean age of 48.4 ± 12.07 years. The weekly average spKt/V was statistically higher with a dialysate flow rate at 1.5 times the blood flow rate compared to the dialysate flow at 500 mL / min (p = 0.001). The proportion of patients achieving a standardized dialysis dose ≥ 1.4 was statistically higher with dialysate flow at 500 mL / min (64.4%) compared to dialysate flow at 1 or 1.2 times the blood flow rate which were 57.8% and 55.6%, respectively. It was statistically higher with a dialysate flow at 1.5 times the blood flow (93.3%) compared to the dialysate flow at 500 mL / min (p = 0.036). The dialysate volume used with a dialysate flow rate of 500 mL / min was higher compared to the other dialysate flow rates (p = 0.0001). Conclusions: An adequate dialysis dose could be achieved with a dialysate flow rate of 1.5 times the blood flow rate, thereby saving significant amount of water.

Comparison of dynamic arterial and venous pressure between metal needles and plastic cannulas in incident hemodialysis patients with arteriovenous graft

2020 ◽  
pp. 112972982091657
Author(s):  
Sun Ryoung Choi ◽  
Pyoungju Park ◽  
Sohee Han ◽  
Cheolsu Kim ◽  
Narae Joo ◽  
...  
Keyword(s):  
Blood Flow ◽  
Venous Pressure ◽  
Hemodialysis Patients ◽  
Blood Pump ◽  
Arteriovenous Graft ◽  
Open Label ◽  
Flow Rates ◽  
Pump Flow ◽  
The Difference ◽  
Metal Needle

Background and objects: We hypothesized that plastic cannulae with 17-gauge inner needle compared to 16-gauge metal needles can have stable dynamic venous and arterial pressure maintaining prescribed blood flow safely during a hemodialysis treatment. Design, setting, participants, and measurements: A single-center, prospective, randomized, open-label clinical trial was conducted involving 16 incident hemodialysis patients who had arteriovenous graft placed as their first arteriovenous access. Subjects were randomized to metal needle group (n = 8) versus plastic cannula group (n = 8). We measured serial dynamic pre-pump arterial and venous pressure under five different blood pump flow rates (150, 200, 250, 300, and 350 mL/min). Results: The mean age of patients was 67.6 ± 8.5 (range: 51–81) years, and six patients (37.5%) were male. Patients with plastic cannula showed less negative arterial pre-pump pressures and lower venous pressures than those with metal needles at all prescribed blood flow rates, and the difference was statistically significant (P < 0.001). Conclusion: The plastic cannula had more stable arterial and venous pressures at prescribed blood pump flow rates than those pressures of the metal needle in incident patients with arteriovenous graft during hemodialysis.

scholarly journals The Regional Cerebral Blood Flow in Patients under Chronic Hemodyalytic Treatment

1987 ◽  
Vol 7 (5) ◽  
pp. 659-661 ◽  
Author(s):  
D. Gottlieb ◽  
B. Mildworf ◽  
D. Rubinger ◽  
E. Melamed
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Regional Cerebral Blood Flow ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Regional Cerebral Blood ◽  
Before And After ◽  
Mild Reduction ◽  
Xenon 133 ◽  
Normal Controls

Regional cerebral blood flow (rCBF) was measured by the xenon-133 inhalation method in an un-selected group of nine chronic hemodialysis patients before and after a single hemodialytic treatment. All patients underwent neurological, neuropsychological, and biochemical evaluations on the same occasions. Predialysis rCBF values did not differ from those obtained in age-matched normal controls. Following hemodialysis, there was a mild reduction in the rCBF by a mean of 7 ± 2.6% (p = 0.02). The posthemodialysis rCBF reduction was not associated with any neurological or cognitive dysfunction. The causes of hemodialysis-induced rCBF decreases are unknown, but increased blood viscosity and biochemical changes, such as urea reduction and blood alkalinization, may play a role.

Central Venous Catheter and the Hemodialysis Patient: A Difficult Symbiosis

2002 ◽  
Vol 3 (2) ◽  
pp. 64-73 ◽  
Author(s):  
S. Mandolfo ◽  
W. Piazza ◽  
F. Galli
Keyword(s):  
Blood Flow ◽  
Central Venous Catheter ◽  
Hemodialysis Patient ◽  
Venous Catheter ◽  
Hemodialysis Patients ◽  
Central Venous Catheters ◽  
Chronic Hemodialysis ◽  
Central Venous ◽  
Tip Position ◽  
Ultrasonographic Guidance

In the last ten years, tunneled central venous catheters (pCVCs) have been increasingly utilized in chronic hemodialysis patients, sometimes in the place of fistulas. They have gained popularity for their unquestioned advantages, such as the possibility for immediate use. However, several problems have emerged following their diffusion. In this paper we review the main complications of pCVCs. Complications connected with insertion are generally due to an inaccurate approach to the vein. Ultrasonographic guidance has partially solved this problem and EC-ECG (endocavitary ECG) allows an accurate positioning of the tip. Infections, venous and/or pCVCs) thrombosis and dysfunctions are the most important catheter-related complications. Infections may occur with and without symptoms of systemic illness. Early diagnosis and appropriate antibiotic treatment are essential for saving the catheter. The pathogenesis of infections and strategies for prevention are discussed. Thrombosis and stenosis are well known complications of subclavian and jugular catheterization. In uremic patients, for temporary use, we suggest using the femoral position. Protocols for application of thrombolytic agents in pCVCs are considered. Dysfunction, defined as the failure to maintain a blood flow of at least 250 ml/min, remains the Achilles’ heel of the system. Adequate look therapy and tip position are only two basic aspects. In conclusion, a pessimistic outlook on the matter could lead us to consider that the advantages of catheter use are far outweighed by the disadvantages. However, we cannot avoid using central venous catheters in our dialysis units and a great challenge awaits both physicians and manufactures in the coming years.

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