Lindsay RM, Bradfield E, Rothera C, Kianfer C, Malek P, Blake
PG
A comparison of methods for the measurement of access
recirculation and access flow
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1412 1996
Each of the three methods tested required injecting an indicator into the
venous return line after reversing the blood lines during hemodialysis. For
the ultrasound dilution and hemoglobin dilution techniques, the indicator
was a bolus of normal saline; for the conductivity method, the indicator
was a bolus of hypertonic saline. Recirculation and access blood flow
measured by the ultrasound dilution and conductivity techniques compared
favorably with each other while the hemoglobin dilution method tended to
overestimate flow and to underestimated recirculation and was less
reproducible.
Comment: The coefficient of variation (CV) for the ultrasound
dilution technique (9.1%) was higher than reported by others whereas the CV
for the conductivity method (7.5%) was similar to that reported previously.
The investigators in this study helped to develop the conductivity method
which requires injecting a bolus of 23% saline directly into the A-V access
as well as a special sterile attachment to the blood line. The ultrasound
dilution technique requires an injection of normal saline into the A-V
access and special non-sterile equipment that clamps onto the blood line.
Both techniques are much more accurate and precise for measuring
recirculation than the older urea dilution method.
(Thomas A. Depner, M.D., University of California at Davis)
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Am Soc Nephrol
Basic hemodialysis :
Vascular Access: graft/fistula