Transonic, thermodilution, or ionic dialysance to manage vascular access: which method is best?

Regularly monitoring blood flow through a vascular access (Qa) can predict a dysfunction and dramatically reduce the number of thromboses. The aim of our study was to compare two integrated access flow devices, thermodilution (Qa-BTM: BTM(®), Fresenius Medical Care, Bad Homburg, Germany) and ionic dialysance (Qa-ID: OCM(®), Fresenius Medical Care, Bad Homburg, Germany), with the "gold standard" saline dilution (Qa-T: Transonic(®), Systems Inc., Ithaca, NY, USA). Measurements were performed sequentially and were repeated in the first 90 minutes of a single dialysis session in 24 long-term hemodialysis patients with a vascular access. Bland-Altman, linear regression (r(2)), and intraclass correlation coefficients (ICC) assessed reproducibility, correlations, and concordance between the techniques. Average access flow for Qa-T was 1549 (± 844) mL/minute, Qa-BTM was 1530 (± 856) mL/minute (P = NS), and Qa-ID was 1619 (± 1085) mL/minute (P = NS). Respectively, ICC, (r(2)), and bias were 0.99, (0.98), and -19 mL/minute for Qa-BTM, and 0.75, (0.65), and +69 mL/minute for Qa-ID. The limits of agreement were -287 to +250 mL/minute for Qa-BTM and -1647 to +1785 mL/minute for Qa-ID. Reproducibility of thermodilution and ionic dialysance, expressed as relative differences, was not significantly different from saline dilution. Recirculation, measured by saline dilution, was 0% (0-4%), the same as the 0% measured by thermodilution, with correct placement of bloodlines and corrected for cardiopulmonary recirculation. The integrated access flow measurement devices, thermodilution and ionic dialysance, are reasonable alternatives to using saline dilution to measure Qa: Thermodilution showed better precision and correlation. They are reliable, make monitoring of vascular access easier, incur no extra costs, and use no additional consumables.
(© 2013 International Society for Hemodialysis.)