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      Non-Specialist Ultrasound Measuring of Access Flow: New Technology

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          A new ultrasound instrument has been developed, using vector Doppler and embedded machine intelligence, to enable measurement of access flow rates by non-specialists. Ultrasound measurement of access flow can be performed with the patient off the dialysis machine, avoiding the hemodynamic changes that may affect indicator-dilution methods. A research version of the instrument was tested on flow phantoms simulating graft flow, and showed accuracy better than 5%. A non-specialist measured flow in the access grafts of 7 consenting dialysis patients; the instrument showed flows commensurate with indicator-dilution-measured flows, but with less variability. Measurements were made in less than 5 min per patient. The cost per measurement is calculated to be significantly less than that of present methods of measuring flow. The new instrument may become a useful tool for monitoring flow in accesses to extend their life.

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          Most cited references 3

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          Validation of a new blood-mimicking fluid for use in Doppler flow test objects.

          A blood-mimicking fluid (BMF) suitable for use in Doppler flow test objects is described and characterised. The BMF consists of 5 microns diameter nylon scattering particles suspended in a fluid base of water, glycerol, dextran and surfactant. The acoustical properties of various BMF preparations were measured under uniform flow to study the effects of particle size, particle concentration, surfactant concentration, flow rate and stability. The physical properties, (density, viscosity and particle size), and acoustical properties (velocity, backscatter and attenuation) of the BMF are within draft International Electrotechnical Commission requirements.
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            A randomized controlled trial of blood flow and stenosis surveillance of hemodialysis grafts.

            It is widely accepted that hemodialysis graft surveillance combined with correction of stenosis reduces thrombosis and prolongs graft survival. Nevertheless, few randomized controlled trials have evaluated this approach. In this randomized controlled trial, 101 patients were assigned to control, flow (Qa), or stenosis groups, and were followed for up to 28 months. All patients had monthly Qa measured by ultrasound dilution and quarterly percent stenosis measured by duplex ultrasound. Referral for angiography was based on the following criteria: (1) control group (N = 34), clinical criteria; (2) flow group (N = 32), Qa 50% or clinical criteria. Stenosis >or=50% during angiography was corrected by preemptive percutaneous transluminal angioplasty (PTA). The preemptive PTA rate in the control group (0.22/patient year) was two thirds the rate in the flow group (0.34/patient year), and was highest in the stenosis group (0.65/patient year, P < 0.01). The percentage of grafts that thrombosed was similar in the control (47%) and flow groups (53%), but reduced in the stenosis group (29%, P = 0.10). Two-year graft survival was similar in the control (62%), flow (60%), and stenosis groups (64%) (P = 0.89). Qa and stenosis surveillance were not associated with improved graft survival, although thrombosis was reduced in the stenosis group. The most important factors in this result may be that monthly Qa and quarterly stenosis measurements were not accurate or timely indicators of risk of thrombosis or progressive stenosis. This study does not support the concept that Qa or stenosis surveillance are superior to aggressive clinical monitoring.
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              Cost Efficacy of Duplex Surveillance and Prophylactic Angioplasty of Arteriovenous ePTFE Grafts


                Author and article information

                Blood Purif
                Blood Purification
                S. Karger AG
                July 2004
                20 January 2004
                : 22
                : 1
                : 78-83
                aDVX, llc, Kingston, N.J., and bRenal Research Institute, New York, N.Y., USA
                74927 Blood Purif 2004;22:78–83
                © 2004 S. Karger AG, Basel

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                Page count
                Figures: 4, References: 19, Pages: 6
                Self URI (application/pdf):

                Cardiovascular Medicine, Nephrology

                Access flow measurement, Vector Doppler, Ultrasound, Hemodialysis


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