KDOQI guidelines suggest an active access surveillance-monitoring program be adopted by all dialysis facilities. Vasc-Alert meets or exceeds the standards set by the KDOQI Table III-5 Dynamic Venous Dialysis Pressure Surveillance Protocol. A point by point comparison of Vasc-Alert with the Dynamic Venous Dialysis Pressure Surveillance Protocol guidelines demonstrates that Vasc-Alert meets or exceeds these standards.

Guideline
Establish a baseline by initiating measurements when the access is first used.
	Vasc-Alert
	The use of a database in the Vasc-Alert system easily permits the establishment of a baseline and allows analysis of trend in access sites measurements.

Guideline
Measure venous dialysis pressure from the hemodialysis machine at Qb 200 mL/minute during the first 2 to 5 minutes of hemodialysis at every hemodialysis session.
	Vasc-Alert
	The Vasc-Alert system does not require a special procedure because it does the monitoring in a dynamic fashion; i.e., while the patient is being dialyzed. Vasc-Alert uses the standard treatment run data collected during these sessions, and tracks these measurements for the entire session up to the last hour.

Guideline
Use 15-gauge needles (or establish own protocol for different needle size).
	Vasc-Alert
	The Vasc-Alert system has been developed based on a 15-gauge needle standard, but it can be used with needles of other gauges.

Guideline
Pressure must exceed the threshold three times in succession to be significant.
	Vasc-Alert
	If Vasc-Alert determines that the patient has high pressures for three consecutive sessions, a warning is sent to center personnel that the patient is at risk for clotting.

Guideline
Assess at same level relative to hemodialysis machine for all measurements.
	Vasc-Alert
	The Vasc-Alert system incorporates corrections due to relative height differences in the calculations.

Guideline
Using 15-gauge needles, the threshold that indicates elevated pressure (and therefore the likely presence of a hemodynamically significant venous outlet stenosis) for Cobe Centry 3 machines is a pressure of 125 mmHg, whereas the threshold for Gambro AK 10 machines is a pressure of 150 mmHg. Data for Baxter, Fresenius, Althin, and other dialysis machines are not available but are likely to be similar to those of the Cobe Centry 3 if the same gauge venous needle is used. Trial and error at each institution will determine each unit's threshold pressure. Trend analysis is more important than any single measurement. Upward trends in hemodialysis pressure over time are more predictive than absolute values. Each unit should establish its own venous pressure threshold values.
	Vasc-Alert
	The Vasc-Alert system calculates a ratio of venous pressure to mean arterial pressure and compares this to a given threshold found to be significant as an indication of a problem. The ratio is adjusted for the blood pump flow, patient hematocrit, and other factors within the machine (tubing, needle, chair height, etc.) so that the comparison to the patient's mean arterial pressure is consistent regardless of the equipment used and the patient's particulars. The Vasc-Alert database provides a graphic view of patient trend data. The emphasis on trending in the guideline reflects the fact that variability in both machines and patients reduces the value of any single measurement on its own. The combination of an absolute threshold viewed in context with trend information provides the medical staff with a very good indicator of those patients at risk.