44th EDTNA/ERCA International Conference – Dresden, September 26-29 2015

Vascular access surveillance and monitoring programme – early intervention benefits

Introduction As the vascular access represents the patient's life line in haemodialysis treatment, regular monitoring and surveillance became a fundamental routine in the multidisciplinary team. Access blood flow (Qa) and recirculation are two important parameters of monitoring vascular access. In NephroCare Portugal, these are obtained using the Blood Temperature Module (BTM®) for thermal dilution. Periodic assessment of the Qa allows for early recognition of potential complications and immediate intervention. Objectives • To understand the importance of vascular access assessment • To recognize the importance of regular assessment of the vascular access using Qa

• To evaluate the results of the interventions (angiograms and angioplasties) performed between January 1, 2013 and December 31, 2014 to decrease the access flow

Methods We conducted a single, retrospective study involving 181 patients with 140 patients having an AVF as vascular access and 41 patients an AVG between January 1, 2013 and December 31, 2014. In NephroCare Entroncamento, assessment of Qa is carried out monthly for AVG and every 4th month for AVF (reference values Qa≤600 ml/min for AVF and Qa ≤400 ml/min for AVG) and in case of a decrease of ≥20% compared to last assessment. We made a second measurement to confirm these values. If the reduction of Qa is confirmed, the patient is referred to angiography and a new assessment is performed after the intervention. Diagnostic angiograms without intervention were excluded.

Patrícia Bento1, Patrícia Lopes1, Ana Reis1, Carlos Marchão1, José Sequeira Andrade1, Ricardo Peralta2, João Fazendeiro Matos2

1Fresenius Medical Care, NephroCare Entroncamento, Entroncamento – Portugal 2Fresenius Medical Care, NephroCare Portugal, Porto – Portugal

References 1. KDOQI. (2006).Updates Clinical Pratice and Guidelines Recommendations. National Kidney Foundation; 2. FISTULA FIRST – www.fistulafirst.org.

Conclusions Regular monitoring of the Qa using thermodilution helps us prevent serious complications in vascular access. An early referral to angiography based on thermodilution measurements is beneficial for the patient (and the clinic) for the following reasons: • Prolongs and preserves vascular access survival • Reduces the need for Central Venous C, thus reducing infection risks • Reduces interventions or creation of a new vascular access • Increases patient comfort and emotional stability

Average Qa values of AVF and AVG

45 angiograms required AVF ≤ 600ml / min and AVG ≤ 400ml/ min

21 in 2013

15 AVG

6 AVF

21 in 2014

11 AVG

10 AVF

42 angiograms performed

Results

Angiograms performed in 2013 and 2014

New access flow

Assessement After

angiography Angiography Qa decrease

375,3 390,6

742,6

455,6 392,8

985,2

0

200

400

600

800

1000

1200

1st Measurement 2nd Measurement Post Intervention Measurement

Acc

ess

Blo

od F

low

(ml/m

in)

Average Qa values of AVF and AVG AVF AVG