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      Sensitivity and Specificity of the Thermodilution Technique in Detection of Access Recirculation

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          Abstract

          Background/Aim: Recirculation measured by thermodilution includes effects caused by access and cardiopulmonary recirculation. The aims of this study were to illustrate the accuracy of thermodilution in measurement of hemodialysis recirculation and also to identify a sensitive and specific threshold to detect access recirculation. Methods: 110 studies were performed in 19 patients. Recirculation obtained directly by the blood temperature monitor (BTM) was compared to that calculated from access blood flow, pump blood flow, and cardiac output determined by ultrasound dilution using the hemodialysis monitor (HDM). Results: A highly significant linear correlation was obtained between repeated BTM recirculation measurements (R<sub>BTM, 2</sub> = 0.99·R<sub>BTM, 1</sub> – 0.22%, r<sup>2</sup> = 0.99). There were no significant differences between repeated BTM recirculation measurements with correct placement (11.4 ± 7.1 vs. 10.9 ± 7.4%, p = NS) or reversed placement (30.0 ± 15.6 vs. 30.2 ± 15.9%, p = NS) of blood lines. A strong linear relationship was obtained between the recirculation determined by thermodilution and the recirculation calculated from HDM measurements (R<sub>calc</sub> = 0.98·R<sub>BTM</sub> – 1.49%, r<sup>2</sup> = 0.95). The mean recirculation obtained by BTM was not significantly different from the recirculation calculated by HDM with correct placement (9.5 ± 2.2 vs. 8.6 ± 2.5%, p = NS) or with reversed placement (25.4 ± 7.8 vs. 23.8 ± 7.7%, p = NS) of blood lines. When a recirculation greater than 15% measured by the BTM was considered as the threshold at which true access recirculation occurred, sensitivity and specificity of the thermodilution method to detect access recirculation were 93 and 98%, respectively. Conclusions: Recirculation measurements made by the BTM are accurate and precise. Even though BTM thermodilution includes effects of cardiopulmonary recirculation, so that low levels of access recirculation might not be detected, a BTM recirculation >15% represents a highly significant access recirculation.

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          Author and article information

          Journal
          NEF
          Nephron
          10.1159/issn.1660-8151
          Nephron
          S. Karger AG
          1660-8151
          2235-3186
          2000
          June 2000
          31 May 2000
          : 85
          : 2
          : 134-141
          Affiliations
          aDivision of Nephrology and Hypertension, Beth Israel Medical Center, and bRenal Research Institute, New York, N.Y., USA
          Article
          45646 Nephron 2000;85:134–141
          10.1159/000045646
          10867519
          © 2000 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Figures: 6, Tables: 2, References: 21, Pages: 8
          Product
          Self URI (application/pdf): https://www.karger.com/Article/Pdf/45646
          Categories
          Original Paper

          Cardiovascular Medicine, Nephrology

          Vascular access, Access blood flow, Recirculation, Thermodilution

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