PMID- 16596536
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20060501
LR  - 20191109
IS  - 1129-7298 (Print)
IS  - 1129-7298 (Linking)
VI  - 5
IP  - 1
DP  - 2004 Jan-Mar
TI  - Comparison of different techniques of hemodialysis vascular access flow 
      evaluation.
PG  - 25-32
AB  - Measurement of vascular access flow (QVA) has been suggested as a method of 
      choice for vascular access quality (VAQ) monitoring. Besides traditional duplex 
      Doppler, a number of bedside methods based mostly on the Krivitski principle of 
      QVA evaluation from recirculation at reversed needles (RX), have been developed. 
      This work compares ultrasonic dilution (UD), taken as a reference, HD01, 
      Transonic Systems; duplex Doppler (DD); thermodilution (TD), BTM, Fresenius; 
      optodilutional RX measurement (ORX), Critline III, R-mode, HemaMetrics; direct 
      optodilutional QVA evaluation from jumpwise changes in ultrafiltration rate at 
      both normal and reversed needles connection (OABF), Critline III, ABF-mode; and 
      direct transcutaneous optodilutional QVA evaluation (TQA), Critline III TQA. 
      Firstly, reproducibility of each method was assessed by duplicate measurement at 
      unchanged conditions. This was followed by paired measurement with each method 
      performed at controlled change in relevant measurement condition (two different 
      extracorporeal blood flows in UD and TD, changed sensor position in TQA). Finally 
      paired measurements by each method and the reference method performed at 
      identical conditions were evaluated to assess accuracy of each method. The simple 
      Krivitski formula QVA= QB(1-RX)/RX was used wherever manual QVA calculation was 
      needed. Very high reproducibility was seen in UD, both for measurement at the 
      same extra corporeal blood flow (QB) (correlation coefficient of duplicate 
      measurement r= 0.9702, n= 58) and for measurement at two different QB (r= 0.9735, 
      n= 24), justifying its current status of a reference method in QVA evaluation. 
      Slightly lower reproducibility of TD measurement at the same QB (r= 0.9197, n= 
      40) and at two different QB (r= 0.8508, n= 168) can be easily overcome by 
      duplicate measurement with averaging. High correlation of TD vs. UD (r= 0.9543, 
      n= 54) makes TD a viable clinical alternative in QVA evaluation. Consistently 
      different QVA obtained at two different QB should prompt closer investigation of 
      anatomical conditions of the access. Use of the simple Krivitski formula in TD 
      (which measures total recirculation, i.e. sum of access recirculation and 
      cardiopulmonary recirculation) brings about underestimation of QVA, which 
      progressively increases from QVA of about 600 ml/min up. Good correlation, 
      although with significant scatter (r= 0.8691, n= 27) was found between the DD- 
      and UD-based QVA. By far the worst reproducibility at the same QB from among the 
      investigated methods was found in ORX (0.6430, n= 23). Also the correlation of 
      ORX vs. UD was lower than in other methods (r= 0.702, n=33) and general 
      overestimation of QVA by about 25% was noted. Correlation of OABF vs. UD (r= 
      0.6957, n= 26) was slightly better than that of ORX and it gave less 
      overestimated values. The TQA method showed very high reproducibility (r= 0.9712, 
      n= 85), however only for unchanged sensor position. Correlation of QVA measured 
      at two different sensor positions was much worse (r= 0.7255, n= 22). 
      Correspondence of TQA vs. UD was satisfactory (r= 0.8077, n= 36). Skilled and 
      experienced operators are a must with this method.
FAU - Lopot, F
AU  - Lopot F
AD  - Department of Medicine, General University Hospital, Prague-Strahov, Czech 
      Republic. f.lopot@vfn.cz
FAU - Nejedly, B
AU  - Nejedly B
FAU - Sulkova, S
AU  - Sulkova S
FAU - Blaha, J
AU  - Blaha J
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Vasc Access
JT  - The journal of vascular access
JID - 100940729
EDAT- 2006/04/06 09:00
MHDA- 2006/04/06 09:01
CRDT- 2006/04/06 09:00
PHST- 2006/04/06 09:00 [pubmed]
PHST- 2006/04/06 09:01 [medline]
PHST- 2006/04/06 09:00 [entrez]
AID - 10.1177/112972980400500106 [doi]
PST - ppublish
SO  - J Vasc Access. 2004 Jan-Mar;5(1):25-32. doi: 10.1177/112972980400500106.