Analysis of novel geometry-independent method for dialysis access pressure-flow monitoring

William F Weitzel¹ , Casey L Cotant¹ , Zhijie Wen² , Rohan Biswas¹ , Prashant Patel¹ , Harsha Panduranga¹ , Yogesh B Gianchandani² and Jonathan M Rubin¹

¹School of Medicine, University of Michigan, Ann Arbor, MI, USA

²College of Engineering, University of Michigan, Ann Arbor, MI, USA

author email corresponding author email

Theoretical Biology and Medical Modelling 2008, 5:22doi:10.1186/1742-4682-5-22


Published:	5 November 2008

Abstract

Background

End-stage renal disease (ESRD) confers a large health-care burden for the United States, and the morbidity associated with vascular access failure has stimulated research into detection of vascular access stenosis and low flow prior to thrombosis. We present data investigating the possibility of using differential pressure (ΔP) monitoring to estimate access flow (Q) for dialysis access monitoring, with the goal of utilizing micro-electro-mechanical systems (MEMS) pressure sensors integrated within the shaft of dialysis needles.

Methods

A model of the arteriovenous graft fluid circuit was used to study the relationship between Q and the ΔP between two dialysis needles placed 2.5–20.0 cm apart. Tubing was varied to simulate grafts with inner diameters of 4.76–7.95 mm. Data were compared with values from two steady-flow models. These results, and those from computational fluid dynamics (CFD) modeling of ΔP as a function of needle position, were used to devise and test a method of estimating Q using ΔP and variable dialysis pump speeds (variable flow) that diminishes dependence on geometric factors and fluid characteristics.

Results

In the fluid circuit model, ΔP increased with increasing volume flow rate and with increasing needle-separation distance. A nonlinear model closely predicts this ΔP-Q relationship (R²> 0.98) for all graft diameters and needle-separation distances tested. CFD modeling suggested turbulent needle effects are greatest within 1 cm of the needle tip. Utilizing linear, quadratic and combined variable flow algorithms, dialysis access flow was estimated using geometry-independent models and an experimental dialysis system with the pressure sensors separated from the dialysis needle tip by distances ranging from 1 to 5 cm. Real-time ΔP waveform data were also observed during the mock dialysis treatment, which may be useful in detecting low or reversed flow within the access.

Conclusion

With further experimentation and needle design, this geometry-independent approach may prove to be a useful access flow monitoring method.