The assessment of a rteriovenous fistulae created for haemodialysis from pressure and thermal dilution measurements

Abstract

A technique is described for the assessment of arteriovenous fistulae created for haemodialysis. This involves the measurement of intrafistula pressures and ‘useful fistula flow’ (UFF). The latter we define as the maximum blood flow available for twin needle haemodialysis without recirculation and without unacceptable pressures in the arterial (‘A’) and venous (‘V⁵) lines. The test circuit resembles that used for conventional haemodialysis except there is ‘A’ and ‘V line pressure and temperature monitoring and no dialyser. Intrafistula pressures are first measured at the time of insertion of the fistula needles. ‘A’ and lV line pressures are then recorded as the extracorporeal blood flow rate is increased in increments from zero to SOOmljmin. A check for recirculation is made at each flow rate.

A bolus of cold saline injected into the ‘V line causes a momentary decrease in ‘A¹ line temperature when recirculation is present; when there is no recirculation, ‘A’ line temperature remains constant. The blood flow rate at which recirculation is first detected will be above the useful fistula flow by definition. This technique allows identification of those patients who obtain high blood flows at the expense of recirculation and thus dialyse inefficiently. Combined pressure and thermal dilution measurements yield valuable information in the investigation of failing or problem fistulae.

Key Words:

• haemodialysis
• arteriovenous fistula
• thermodilution
• blood flow velocity
• blood vessels