Difference between delivered and prescribed blood flow in hemodialysis

Area of Science:

• Nephrology
• Biomedical Engineering
• Clinical Trials

Background:

• Accurate blood flow (QB) is crucial for effective hemodialysis treatment.
• Discrepancies between prescribed and delivered QB can compromise patient outcomes.
• The Transonic hemodialysis monitor is a tool used to measure QB during treatments.

Purpose of the Study:

• To compare delivered versus prescribed blood flow (QB) in hemodialysis patients.
• To identify factors influencing the accuracy of delivered QB.
• To assess the impact of different dialysis parameters on QB delivery.

Main Methods:

• Analysis of 208 hemodialysis treatments using the Transonic hemodialysis monitor.
• Comparison of delivered QB with prescribed QB across various pump settings (200-500 cc/min).
• Evaluation of QB delivery based on vascular access type (Permcaths vs. others), needle gauge, and dialysis machine (Baxter vs. Fresenius).

Main Results:

• Delivered QB was often significantly lower than prescribed, especially with Permcaths and at higher pump settings.
• Patients using 14-gauge needles achieved higher delivered QB than those using 15-gauge needles.
• Baxter 550 machines showed lower delivered QB compared to Fresenius 2008H machines, with higher rates of QB falling below prescribed levels.

Conclusions:

• Delivered blood flow during hemodialysis frequently falls short of the prescribed rate.
• Vascular access type, needle gauge, and dialysis machine significantly influence QB delivery accuracy.
• Further investigation is needed to understand and address the factors contributing to QB discrepancies.