Vascular Access Blood Flow Estimation Based On Standardized Extracorporeal Blood Flow in Hemodialysis Patients

Abstract Background: Measurement of vascular access flow (Qa) is a recommendation in the care of hemodialysis patients. We developed an observational study to answer the following question: Can access blood flow be estimated?Methods: This observational study was carried out in the hemodialysis unit of the José Carrasco Arteaga Hospital in Cuenca-Ecuador. The sample calculation was 41 cases. Patients older than 17 years with stage 5d chronic renal failure and vascular access with arteriovenous fistula were included. The variables were descriptive of the population: Qa and extracorporeal blood flow (Qb). Qa measurement was performed with the Transonic ® monitor. Qb was measured at dynamic arterial line pressures (DALPs) of -60 mmHg, -100 mmHg, -160 mmHg, and -200 mmHg. The correlation coefficient "r" was obtained between Qa and Qb. SPSS 22.0 was used to analyze the information and perform a linear regression equation to estimate access blood flow (eQa).Results: Fifty-seven patients aged 62.9 ± 12.7 years with 29.4 ± 33 months on hemodialysis were included; 23 women (40.3%) and 45.6% had diabetic nephropathy. Fistulas were seen in 40 cases in the left upper limb (70.2%) and 17 (29.8%) in the right upper limb. The prevalence of aneurysms was 10.5%. The 50th percentile of Qb was 415 mL/min with a DALP of -200 mmHg. The mean access flow was 1516 ± 878 ml/min. The correlation between Qb and Qa was statistically more significant between Qb and DALP of -200 mmHg. The association had a coefficient Rs = 0.643 (IC 0.453 to 0.771) P <0.0001. The estimated access flow eQa = (Qb at DALP of -200 mmHg (mL/min) * 16.63) - 5449.71.Conclusions: It was possible to estimate access blood flow with parameters for easy intradialysis measurements. The equation obtained, if applied to the same patient with the same DALP, could become a useful parameter for monitoring vascular access.Trial registration: ClinicalTrials.gov Identifier: NCT00522704. Registered 14 March 2008, https://clinicaltrials.gov/ct2/show/NCT00522704

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Arterial line pressure control enhanced extracorporeal blood flow prescription in hemodialysis patients

BMC Nephrology ◽

10.1186/1471-2369-9-15 ◽

2008 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Franklin G Mora-Bravo ◽

Alfonso Mariscal ◽

Juan P Herrera–Felix ◽

Salvador Magaña ◽

Guadalupe De-La-Cruz ◽

...

Keyword(s):

Blood Flow ◽

Pressure Control ◽

Hemodialysis Patients ◽

Arterial Line ◽

Extracorporeal Blood ◽

Line Pressure

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Blood Flow Rate and Access Recirculation in Hemodialysis

The International Journal of Artificial Organs ◽

10.1177/039139889201500805 ◽

1992 ◽

Vol 15 (8) ◽

pp. 470-474 ◽

Cited By ~ 16

Author(s):

I.D. Daniels ◽

G.M. Berlyne ◽

R.H. Barth

Keyword(s):

Blood Flow ◽

Flow Rate ◽

Blood Flow Rate ◽

Hemodialysis Patients ◽

Blood Pump ◽

Concomitant Increase ◽

Urea Clearance ◽

Extracorporeal Blood

We studied the effect of extracorporeal blood flow rate (BFR) on access recirculation (recirc) in 19 hemodialysis patients. BUN was determined in simultaneous peripheral (P), arterial (A), and venous (V) blood obtained at BFRs of 200, 400 and 600 ml/min. Percent recirc was calculated for each BFR using the formula (P-A) / (P-V) X 100. Venous drip-chamber (VP) and pre-blood-pump (AP) pressures were measured at each BFR. Fistulograms were performed in 10 patients, and stenoses were identified in 5, all at the proximal (arterial) end of the access. Recirc increased with increasing BFR from 200 to 400 ml/min but increased little from 400 to 600 ml/min. At all BFRs recirc in the stenotic patients was higher than that of non-stenotic or unstudied patients. Urea clearance, corrected for recirc, rose with blood flow both in stenotic and non-stenotic patients. There were no differences in AP or in VP between stenotic and non-stenotic patients. At BFR ≥ 400 ml/min, a recirc threshold of 15% identified stenoses with sensitivity 100% and specificity 71%. We conclude (1) recirc increases with increasing BFR but not enough to outweight the concomitant increase in urea clearance; (2) significant access stenosis and recirc may be present even with low VP; (3) recirc was associated with arterial side stenoses; (4) at BFR ≥ 400 ml/min, access stenosis is associated with recirc > 15%.

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Clinical utility of far-infrared therapy for improvement of vascular access blood flow and pain control in hemodialysis patients

Kidney Research and Clinical Practice ◽

10.1016/j.krcp.2015.12.001 ◽

2016 ◽

Vol 35 (1) ◽

pp. 35-41 ◽

Cited By ~ 5

Author(s):

Soo Jeong Choi ◽

Eun Hee Cho ◽

Hye Min Jo ◽

Changwook Min ◽

Young Sok Ji ◽

...

Keyword(s):

Blood Flow ◽

Vascular Access ◽

Pain Control ◽

Clinical Utility ◽

Far Infrared ◽

Hemodialysis Patients

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Survival and Clinical Outcomes of Tunneled Central Jugular and Femoral Catheters in Prevalent Hemodialysis Patients

Blood Purification ◽

10.1159/000494206 ◽

2018 ◽

Vol 47 (1-3) ◽

pp. 132-139

Author(s):

Gerardo Guillermo-Corpus ◽

Jesus Manolo Ramos-Gordillo ◽

José Carlos Peña-Rodríguez

Keyword(s):

Blood Flow ◽

Clinical Outcomes ◽

Infection Rate ◽

Vascular Access ◽

Lower Extremities ◽

Hemodialysis Patients ◽

Low Risk ◽

Risk Of Infection ◽

Upper And Lower Extremities

Background: The literature on the outcomes of tunneled femoral catheters compared to that of jugular catheters is scarce and derived mainly from small cohorts. Material and Methods: Seven hundred and sixty six catheters were placed in 673 hemodialysis patients, 622 in the jugular/subclavian veins and 144 in the femoral veins. Patients were followed prospectively for 36 months. Results: The survival of the tunneled catheters was 771 days 95% CI (737–805) for jugular and 660 days 95% CI (582–739) for femoral veins. Blood flow (0.292 ± 0.003 L/min) and infection rate (0.25 × 1,000 days/catheter) were similar for upper and lower extremities vascular accesses. Factors including sex, age, diabetes and previous catheters did not affect the outcome. Conclusions: Femoral catheters provide outstanding vascular access with excellent, function and low risk of infection.

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Early Vascular Access Blood Flow as a Predictor of Long-term Vascular Access Patency in Incident Hemodialysis Patients

Journal of Korean Medical Science ◽

10.3346/jkms.2010.25.5.728 ◽

2010 ◽

Vol 25 (5) ◽

pp. 728 ◽

Cited By ~ 10

Author(s):

Hyung Soo Kim ◽

Jin-woong Park ◽

Jae Hyun Chang ◽

Jaeseok Yang ◽

Hyun Hee Lee ◽

...

Keyword(s):

Blood Flow ◽

Vascular Access ◽

Hemodialysis Patients

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SAT-250 FAR INFRARED THERAPY: EFFECTS ON VASCULAR ACCESS BLOOD FLOW, KT/V AND NEEDLING PAIN IN HEMODIALYSIS PATIENTS

Kidney International Reports ◽

10.1016/j.ekir.2020.02.266 ◽

2020 ◽

Vol 5 (3) ◽

pp. S106-S107

Author(s):

S.F. KHALID ◽

N.H. Abd Ghani ◽

W.M.Z. Wan Ibrahim ◽

M.F. Ghazalli ◽

L. Mushahar

Keyword(s):

Blood Flow ◽

Vascular Access ◽

Far Infrared ◽

Hemodialysis Patients

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Transposition of the superficial femoral artery combined with ultrasound-guided returning-venous cannulation as a last resort for vascular access in a multi-complicated hemodialysis patient

The Journal of Vascular Access ◽

10.1177/11297298211023288 ◽

2021 ◽

pp. 112972982110232

Author(s):

Hiroaki Matsuda ◽

Yoshinari Oka ◽

Nozomu Otaka ◽

Kazufumi Sakurama ◽

Shigeko Takatsu ◽

...

Keyword(s):

Upper Limb ◽

Vascular Access ◽

Femoral Artery ◽

Brachial Artery ◽

Superficial Femoral Artery ◽

Hemodialysis Patient ◽

Hemodialysis Patients ◽

Venous Cannulation ◽

Ultrasound Guided ◽

Blood Drawing

A superficialized artery as a blood-drawing route could be an option for vascular access (VA) in hemodialysis patients with cardiac failure, vessel damage, steal syndrome, and venous hypertension, and it could be a secondary VA option in those with repetitive vascular access troubles, routinely requiring a blood-returning venous route. The brachial artery is preferably used for superficialization due to the benefit of its appropriate diameter for cannulation, procedural ease of surgery under local anesthesia, and usable subcutaneous vein for blood-returning route in the upper limb. The superficial femoral artery (SFA) has also been reported as a candidate for arterial transposition; however, its subcutaneous transposition could have difficulties in requiring general anesthesia and securing blood-inflow-venous routes. We experienced a multi-complicated hemodialysis patient who had intractable tunneled-cuffed catheter-related bacteremia and right atrial thrombosis, low cardiac function with bilateral proximal bifurcation of the brachial artery at the axilla, and damaged cutaneous veins in the upper limb. Herein, we report a case of successful superficialization of the SFA under ultrasound-guided regional anesthesia combined with local anesthesia and intravenous sedation, which could be feasible as a blood-drawing route with ultrasound-guided ipsilateral greater saphenous vein cannulation during chronic hemodialysis. Assisted by ultrasound-guided venous cannulation in the ipsilateral lower limb, cutaneous repositioning of the SFA could be a viable and acceptable option for VA in hemodialysis patients with a multitude of complications, wherein the possibilities of VAs of arteriovenous access, arterial superficialization using vessels in the upper extremity, or artificial devices should be eliminated.

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