Usefulness of a Novel Vascular Access Management Method Using a Laser Blood Flowmeter.

INTRODUCTION: Various methods for vascular access (VA) management have been studied. We investigated the usefulness of a new, simple, and quantitative VA management method using the Pocket LDF® laser blood flowmeter (hereinafter "LDF") that noninvasively measures peripheral circulation flow. METHODS: Peripheral circulation flow was measured in 82 patients (43 men) on maintenance hemodialysis with an arteriovenous fistula (AVF). The shunt symmetry index (SSI) was calculated as peripheral circulation flow in the AVF limb divided by that in the non-AVF limb. SSI was used for microcirculation evaluation and also compared by AVF site. Patients undergoing vascular access interventional therapy (VAIVT) underwent ultrasound evaluation (Doppler ultrasonography) of the AVF and SSI measurement before and after VAIVT. SSI was compared between those who did and did not require VAIVT, and the cutoff value for SSI was determined by receiver operating characteristic curve (ROC) analysis. RESULTS: As many as 86% of the patients who were measured peripheral circulation flow had SSI <1.0, which indicates that AVF reduced peripheral circulation flow. All patients who underwent VAIVT showed a decrease in SSI to <1.0 after VAIVT, probably due to improvement of stenosis. SSI differed significantly between patients who did and did not require VAIVT (1.20 ± 0.49 vs. 0.65 ± 0.33, p < 0.001), which indicates that SSI is affected by the presence of stenosis in the proximal vein of the VA anastomosis. In patients with SSI ≥1.0, stenosis of the proximal vein of the AVF caused stasis of blood flow, resulting in increased peripheral blood flow. AVF site seems to have no impact on peripheral circulation flow. The SSI cutoff value for the screening of proximal vein stenosis was 1.06 (sensitivity: 0.69, specificity: 0.93, area under the curve: 0.81). CONCLUSION: Based on the ROC analysis, we recommend considering AVF ultrasound for SSI >1.06. Our results suggest the usefulness of the described VA management method using the LDF.

Japan's Support of Hemodialysis in Southeast Asia.

BACKGROUND: With continuing economic development in the developing countries of Southeast Asia, the numbers of dialysis facilities and patients are increasing every year. However, dialysis-related devices tend to be provided with financial support from developed countries and/or donations from nonprofit organizations, and some donated devices are disposed of, without attempts at repair, when they break down. Device management and dialysate quality can also be problematic. SUMMARY: To help address these issues, Japan started to provide technical guidance and support for dialysate purification in these countries. As a result, dialysate quality improved and local medical staff can now perform dialysis therapy using purified dialysate. At the same time, education was provided to staff, and their improved knowledge and skills have contributed to appropriate device maintenance, ensuring the dialysate used is of sufficient quality. Currently, approaches for human resource development are being actively provided in these countries through cooperation with local academic societies or other organizations in the field. Key Messages: A review of the current status of management of dialysis-related devices and dialysate quality in developing countries reveals that financial support and donations for medical devices alone are insufficient and the development of local human resources is crucial. Nurturing and training of clinical engineers, who directly operate today's advanced medical devices for patients, as well as device maintenance and management are urgent issues to address.