Vascular access dysfunction, including stenosis and thrombosis, is the leading cause of arteriovenous vascular access failure and conversion to a central venous catheter. These complications may be minimized by having proper access care, including monitoring and surveillance, and prompt referrals for vascular access evaluation when abnormal results are detected. Vasc-Alert, the new “Gold Standard” in vascular access surveillance, can help streamline your vascular access management program because it provides ongoing results with each dialysis treatment.
Continue reading to learn more about how Vasc-Alert is able to help identify and prioritize your patients for vascular access referral.
What is Vasc-Alert Surveillance?
Vascular access surveillance is periodic testing of arteriovenous vascular access sites using a medical device. Vasc-Alert surveillance is achieved by analyzing treatment data recorded in the electronic medical record and monitoring reports for increasing trends in intra-access pressure at both the venous and arterial needle sites. Abnormal results, which are termed Alerts in the reports, may indicate a problem with your patient’s access. Vasc-Alert provides results for every treatment.
How does it work?
Before we start producing reports, each facility that uses Vasc-Alert provides information regarding the dialysis machines, bloodlines and needles in use. This background information is needed to create results that are specific to your facility. We also set up a routine to transmit treatment data and the most recent hemoglobin or hematocrit, so that we can make surveillance calculations specific to each patient. All of this data is needed to accurately calculate your patients’ intra-access pressure results. This data driven approach enables Vasc-Alert to test the access with every dialysis treatment.
Once the previous steps are completed, we can begin analyzing data and producing reports. Averaged treatment results are generated by making calculations for each observation, and then averaging those results to provide a single result for each treatment. The results include Venous Access Pressure Ratio (VAPR), Arterial Access Pressure Ration (AAPR), delivered treatment Blood Flow Rate (BFR) compared to prescribed BFR, average Venous Pressure (VP) and average Arterial Pressure (AP). When the calculated VAPR or AAPR exceed the FDA cleared threshold for three consecutive treatments an Alert is generated in the reports.
Recently we have also included an Access Risk Score (ARS) that uses components of the surveillance reports to rank results on 1 to 10 scale, where 1 is the least risk and 10 is the most for vascular access dysfunction. The ARS is included in the traditional Patient Detail Reports and in the weekly Triage List Report.
How Do I Use the Reports?
Patient Detail Reports are available to be viewed online or as weekly PDF reports. These reports are separated into 2 sets. The first is for patients who are on Alert in our system. These are the patients who are triggering potential access issues. To be included in this list a patient must have 3 consecutive treatments with results above our FDA cleared threshold for VAPR and/or AAPR in the previous 30 days. The threshold corresponds to a 50% to 60% occlusion in the access, which is the level of stenosis necessary for an intervention to be reimbursed by insurance. Using these reports along with consideration of other indicators of vascular access dysfunction helps clinicians to identify patients with potential access problems to consider for referral for vascular access evaluation.
A second set of Patient Detail Reports for patients who are not on alert is also produced, so that clinicians can periodically review all patients’ results based on their facility’s policy for vascular access management.
The Triage List Report was created to help streamline the referral process and identify the patients with highest risk of access dysfunction, so that they are prioritized. The Triage List Report has also been used successfully with a referral protocol based on the ARS to decrease thrombectomies and conversions, while increasing appropriate angioplasty procedures.
How can I learn more about Vasc-Alert’s reports?
We have created a podcast that reviews the basics of our reports and how they can be used in your vascular access management program. It is available here:
You may also use the contact link at Vasc-Alert.com to request a demonstration or additional training.