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Creating Radio-cephalic Arteriovenous Fistula in the Forearm with a Modified No-Touch Technique
Published on: April 1, 2022
Study of arteriovenous fistula function by the temperature gradient method using the Twister™ device
Ramon Roca-Tey1, Rosa Samon, Omar Ibrik
1Hospital de Mollet, Mollet del Vallès, Barcelona, Spain.
Summary
The temperature gradient method (TGM) with the Twister™ device accurately measures arteriovenous fistula (AVF) blood flow in hemodialysis (HD) patients. This method is faster than the Delta-H technique and shows no correlation with patient blood pressure.
Area of Science:
- Nephrology
- Vascular Surgery
- Medical Devices
Background:
- Periodic blood flow (QA) measurement is crucial for arteriovenous fistula (AVF) surveillance in chronic hemodialysis (HD) patients.
- Assessing AVF function helps prevent complications and ensure effective treatment.
Purpose of the Study:
- To evaluate the efficacy of the temperature gradient method (TGM) using the Twister™ device for determining AVF blood flow (QA).
- To compare the TGM's functional results with the established Delta-H method.
- To investigate the influence of blood pressure on AVF function.
Main Methods:
- Non-invasive QA measurement in 30 AVF patients during HD using TGM with the Twister™ device.
- QA calculation via blood temperature monitor (BTM) readings at normal and reverse blood line configurations.
- Simultaneous measurement of mean arterial pressure (MAP).
- Comparison with AVF blood flow determined by the Delta-H method.
Main Results:
- The TGM with Twister™ demonstrated reproducible QA measurements (CV 6.8 +/- 4.7%).
- Mean QA was 1132.5 +/- 515.4 ml/min, with no significant difference between diabetic and non-diabetic patients.
- No correlation was found between QA and age, time on HD, MAP, Kt/V, needle distance, or AVF duration.
- TGM with Twister™ (5.9 min) was significantly faster than Delta-H (26.8 min) (p < .001).
- TGM-derived QA highly correlated with Delta-H measurements (r = 0.963, p < .001).
Conclusions:
- The TGM is a valuable, reproducible method for QA measurement during HD.
- The Twister™ device significantly reduces the time required for TGM QA measurements.
- TGM and Delta-H methods yield highly correlated AVF blood flow values.
- AVF function, as measured by blood flow, is not significantly related to patient blood pressure.
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Step 1: Perform hand hygiene and don a fresh pair of gloves to prevent cross-infection and ensure patient safety.
Step 2: Explain the procedure to the patient to establish trust. Clear communication establishes trust with the patient, ensures they understand what to expect, promotes cooperation, and enhances comfort during the procedure.
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