ACCESS FLOW (AQ) IN PEDIATRIC PATIENTS MEASURED BY ULTRASOUND DILUTION (UD)

Provision of adequate hemodialysis depends on a properly functioning vascular access (VA). VA flow (AQ) is a good predictor of access failure. Venous stenosis is a problem of permanent access leading to decreased AQ and predisposing to thrombosis. Inadequate AQ decreases quality of dialysis. UD monitoring is a rapid, simple and non-invasive method for assessing AQ in adults during dialysis. Our unit is the first pediatric unit to study AQ via UD. AQ measurement via UD was made using a single 20-ml bolus of normal saline in 15 pediatric pts. (8 males, 7 females; 10 AVG, 5AVF; wt 46.3 kg +/- 10.5 kg, range 24.9 kg to 62 kg; 8 pt [is less than] 40 kg). 98 AQ UD measurements were made from April to Nov. 2000. UD was reproducible with [is less than] 10% intra-patient variation between results obtained within 5 minutes. 23 venograms were performed within one week of UD measurement: 11 showed [is less than] 50% stenosis, 12 showed [is greater than] 50% stenosis. AQcorr was 1279 ml/min/1.73m2 +/- 364 for pt with [is less than] 50% stenosis versus 475 ml/min/1.73m2 +/- 285 for pts with [is greater than] 50% stenosis (p [is less than] 0.0001). All but one pt with stenosis had AQcorr [is less than] 700ml/min/1.73m2. This pt with Aqcorr [is greater than] 700 and stenosis had a month to month AQcorr decrease of 33%. One pt had redevelopment of stenosis with a 50% month to month decrease of AQcorr. UD is a simple, painless and non-invasive portable bedside technique that gives rapid AQ results and is a good predictor of venous stenosis. Our study shows that UD can detect timely VA flow information to predict venous stenosis and potentially prevent thrombosis in children. Early detection of VA stenosis and corrective angioplasty could lead to significant decrease in health care costs and acute pt morbidity. Effective monitoring will prolong VA patency and contribute to the well-being of pediatric patients.
Allsteadt AG, BSN, RN, CNN Texas Children's Hospital Houston,Texas Currier H, RN, CNN, Texas Children's Hospital, Houston, Texas Goldstein SL, MD, Baylor College of Medicine, Houston, [...]