Just a general technology question for the forum.  I am ordering new ultrasound equipment for our surgery center.  There have been recent advances allowing for hand-held US technology, such as the Sonosite iVis, Android, and Ipad devices.  However, I don't see any handheld US equipment which can measure fistula flow / pulse wave doppler.  I evaluate new fistulae by US to access maturation and measure flows.

Does anyone know if there are any hand-held US devices which can measure flow?  Thanks.

Ultrasound guided cannulation is slowly becoming the standard of care outside the US.  See the 2017 guidelines on the use from Canada.  As IN’s you routinely use ultrasound imaging.  Many of you may even provide cannulation maps of a patient’s access to the dialysis unit.   The Associates program at the Feb meeting will be reviewing cannulation techniques and the issue of ultrasound imaging.  Wanted to get feedback on the interest in ultrasound guided cannulation or at least visualization before cannulation by your dialysis staff.  Do you support the idea?  Would an easy to use non-diagnostic imaging be of value to your clinics?  What about cost of the device?  The major adoption hurdle of training has already been disproven by Dr. Agarwal's study utilizing an easy to use simple point and see device.   

Again, ASDIN has an opportunity to lead the way in vascular access.  Please help our colleague with her inquiry below.

A social worker posted on the CNSW listserv that her patient had a clotted access that has caused a lot of pain over the last few years, so we are cross-posting here. Patient now has a CVC and is getting a fistula in her other arm. The patient has swelling and pain in the arm where the fistula is clotted and has told the Social Worker that when the CVC is used it feels like her veins are being pulled out. Her surgeon has told her there isn’t a surgical option to resolve the pain she is feeling. Hate to hear of a patient having pain during each dialysis treatment.   Asking for ideas to see if you have tips or suggestions.

Dear Colleagues,

We had the Privilege to perform our first three endovascular AVF's using the wavelinQ system early this week.

All were an immediate technical success. We will follow the patients closely to the time of cannulation. 

I am very grateful to my team at the VAC and the patients that put their trust on us.

Here are the most meaningful images of our very first patient - these include a the final run and blood flow volume by me two days later

The second video is the final run of the second patient. 

The third is a still corresponding to the final patient.

Now we will follow them until the are ready to be accessed

Thanks,

Alejandro Alvarez

SSM VAC STL MO

ASDIN Members - We have received an inquiry from a CRNA on grafts clotting during surgery..  Please assist by responding to this post.

From Michael-Malachi Cohen CRNA, MSN

We have had at least 3 Dialysis grafts fail during surgery.  The cases were at least 4 hours each and with the patient in Trendelenburg positioning.  None of the cases involved direct pressure on the graft sites.  If possible please supply any information, algorithm, or standard of care that you have available on intraoperative monitoring of these access sites. 

Thank you for your time and effort as you look into this for our facility. 

Malachi

All - The link has been updated.

https://sites.google.com/site/abigailsarticles/september-2018-articles_1