Vascular dialysis access flow measurement: Early intervention through early detection

Aim: The aim of the project is to determine the effectiveness of using online access flow measurement, thermodilution method (Fresenius BTM™), in detecting and predicting thrombosis or stenosis of the haemodialysis fistula, so that early intervention could be instituted. Methodology: All haemodialysis patients with permanent vascular dialysis access, either arteriovenous fistula (AVF) or arteriovenous fistula graft (AVG), in a large tertiary referral Dialysis Service in Australia were included in this prospective observational quality project, conducted over 12 months. Results: Out of 165 patients studied, 36 patients were found to have poor dialysis access flow, defined as AVF-flow of <200 ml/min or a decrease of 25% from last measurement or AVG-flow of <600 ml/min or a decrease of 25% from last measurement. Doppler ultrasounds were performed, and confirmed findings of significant stenosis, either on the arterial or venous sites, as indicated by poor dialysis access flow results. Conclusion: Thermodilution technique is a reliable and effective method of detecting poor dialysis access flow for patients with permanent vascular access, comparable with other techniques.