"Monitoring Vascular Access and Cardiac Output with Transonic HD01 Monitor".

Barril G. and Selgas R. on behalf of the Spanish multicenter group on

D. Nephrology. H.U. La Princesa. Madrid. ESPAĐA
cigarran@ctv.es

We have started a project of monitoring vascular access follow-up by ultrasound-dilution technique (Krivitski) in 507 HD patients, 298 (59%) males with a mean age 64,20▒14,04 years, from 13 Spanish HD units .

Parameters evaluated:

    1) type of VA: autologous in 79,4% and PTFE graft in 20,6%. The autologous have been divided in radiocephalic and elbow
    2) Systolic and diastolic arterial blood pressure
    3) Venous pressure (VP)
    4) Recirculation (R1)
    5) Pump blood flow (Qb)
    6) Blood flow by Transonic (Qt)
    7) Access Flow
    8) Needle size and
    9) Kt/v
    10) Cardiac Output.

Moreover, we compared the measurement with needles in direction to the flow (21,6%) or against the flow (78,4%). xVP R-C 132,11▒33,61 vs x VP elbow 144,33▒30,29 (p=0,009). x Access Flow radiocephalic 814,82▒493,37 vs x Elbow Access flow 1129▒495,7 (p=0,003).

Overall summary considering all vascular access in first and second measurements.
Qb1 327,99▒43,79 Qb2 327,96▒52,28 ns
p 0,000 p 0,000
Qt1 301,50▒49,21 p 0,000 Qt2 312,86▒46,01 ns
Access F.1 883,66 ▒ 517,22 Access F2 918,47▒533,95 ns
VP1 140,49▒36,07 VP2 148,75▒36,56 ns

Autologous AVF
Access F1 913,71▒532,71 Access F2 913,03▒556 ns
VP1 873,03▒487,06 VP2 145,09▒36,65 0,018
PTFE Grafts
Access F1 873,03▒487,06 Access F2 913,03▒556 ns
VP1 171,33▒41,82 VP2 163,08▒32,88 0,018


Conclusions:

    1) The prevalence of autologous VA is higher than that of PTFE grafts in our population; however, females require grafts much more frequently than males

    2) There is a significant difference between Qb and Qt, being the biggest in autologous VA

    3) More proximal (elbow) autologous VA provide a significant higher blood flow

    4) Comparing autologous and PTFE grafts VA, we did not see significant differences in the access blood flow, although VP was higher among

    5) The monitoring at 3 months did not reveal differences in measurements.


Summary. Transonic monitor seems to be useful in autologous and in PTFE vascular accesses. There are no differences in the measurement of vascular access (VA) parameters between autologous fistula and PTFE grafts by ultrasound dilution technique