Vascular dialysis access flow measurement: early intervention through early detection

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.

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.

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.

Thermodilution technique is a reliable and effective method of detecting poor dialysis access flow for patients with permanent vascular access, comparable with other techniques.