Use of Crit-Line Delta H Access Blood Flow in a Vascular Access Management Program to Decrease Episodes of Thrombosis and Increase URR

Substantial morbidity occurs within the hemodialysis population due to complications of vascular access, most frequently manifests as thrombotic events. An access management goal was the reduction of thrombotic events and associated morbidity. Intra-dialytic vascular access blood flow (ABF) measurements using Crit-Line Delta H ABF have been previously shown to provide objective and accurate access flow data and were our primary method of evaluating access function. A designated ‘access manager’ was assigned responsibility to track all issues related to vascular access. Each patient's ABF was measured monthly and the flow ‘trend’ was graphed using Crit-Line Access Manager software. Additional data, including auscultation, cannulation difficulties, failing URR, and increased venous pressures were also recorded. These data and ABF trends were used to establish an angiography ‘hot list’. Following angioplasty, ABF was again measured to confirm a successful intervention. The ‘hot list’ led to 43 angiography referrals of which 83.7% (36/43) required subsequent intervention resulting in significant reductions of thrombosis events in PTFE grafts and native fistulae. The annual incidence of thrombotic events decreased from 1.6 to 0.4 events/patient year in grafts and 0.5–0.0 events in fistulae. Additionally, the percentage of URR's > 70 increased from 82.3 to 90.1% over the same time period. Use of the Crit-Line Delta H ABF device in conjunction with a vascular access management program can significantly reduce the number of thrombotic events per patient year.