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Home > Improving Care > Stenosis Monitoring

Stenosis Monitoring

In 2002, 25% of patients sampled in Network 6 were routinely monitored for graft stenosis. 2008 Stenosis Monitoring Results

After review of the Clinical Performance Measures (CPM) forms, it was observed that some facilities might have been confused about acceptable methods of stenosis monitoring, resulting in a falsely low reported rate of stenosis monitoring.

“Routine surveillance”, for purposes of CPM reporting, is defined as “the sequential measurement of access flow OR of venous pressure” and includes the following methods.

Access flow surveillance methods

• In-center access flow measurements—done by reversing bloodlines to induce recirculation. Access flow is then calculated either manually, using mathematical formula, or via computer program. May be done using Transonic ®, Cardiodynamic ®, or similar device or may be accomplished using hemodialysis machine with access flow measurement option. Measurements must be repeated on a routine basis to qualify as surveillance.
• Color-Flow Doppler study every three months. This outpatient radiological procedure may also be referred to as a duplex ultrasound, duplex Doppler study, or Doppler color-flow study This method combines conventional ultrasound, which reveals the structure of vessels, with Doppler ultrasound, which reveals blood flow images.

Venous pressure surveillance methods

• Dynamic venous pressure every hemodialysis session during data collection time frame. Though not the first choice of K/DOQI panelists, dynamic venous pressure is often considered to be the most “user-friendly” method of access surveillance. With this technique, venous pressure is recorded at a pump speed of 200 mls/min during the first 2-5 minutes of every dialysis treatment, using the same size fistula needle each treatment, usually 15-guage. While baseline pressures vary with different machines, pressure readings should be close to 125-150 mmHg. Three consecutive readings greater than 150 (or facility specific baseline as determined by medical director) are significant and should prompt further study (fistulagram).
• Static venous pressure (SVP) measured and recorded once every two weeks. SVP monitoring is preferable to dynamic venous pressure monitoring by the K/DOQI workgroup. This method, somewhat more detailed than dynamic monitoring, requires consistency in measurements and use of a simple formula to calculate intra-access pressure ratio. More information on this method is available on the K/DOQI website.
• Stenosis Monitoring Toolkit