The FAS endoluminal brush is a new device used to restore patency in HD catheters. There is use in England which has so far demonstrated significant reduction in urokinase use and costs. I am hoping to learn more about how this brush may be used in dialysis in the USA.

I am not familiar with that specific device- with de-clots any type of declot device or technque seems to work- the important issue is finding the cause of the clot and treating the cause such as venous stenosis up stream. Is the brush used in x-ray? then a fistulagram can be done- narrowing found and angioplasty done to correct the cause or the graft or the gratf will re-clot no matter the de-clot technique. What is the cost of the brush? Who makes it?

The Endoluminal Brush is used for both diagnostic purposes as well as restoring patency.When used diagnostically the cost is a bit higher due to required supplies (U.S. $25.00). When used to restore or maintain patency the cost is closer to ($17.00 U.S.). The source for US distribution is under review. A request to fast track the Brush is being considered in light of the recent FDA warnings regarding urokinase use. When used as part of regular therapy the brush prevents build of fibrin in HD catheters.An effort is under review to have the Brush packaged in bulk (ie. 10 to a pack with each brush in its own sterile container). This will help reduce costs.The Brush will be available in Canada starting next month.

Sorry David,
I miss read your first post- this is for HD catheters not AV access? How does if treat a fibin sheath that has formed from the vessel puncture site down to the tip of the HD catheter?

Hello again,
sorry for the delay in response, I have been traveling. I was glad to see you reviewed the concept. While the Brush is unable to correct the extraluminal growth of fibrin in the general sense...the Brush, upon exiting the tip (much like a guide wire does), grabs the portion of fibrin that develops as a 'flap' over the catheter tip. In many cases patency can be restored in a matter of minutes. It is not a 100% effective method, but has proven to solve most partial occlusions and some complete occlusions. The technique may prove to help maintain patency in most reduced flow situations. There will be material available at the CHICA conference in New Brunswick the 3rd week of June. I look forward to your questions and appreciate your comments to help me better understand the Brush's application in Dialysis.
David

Hello again,
I suspect that this is a related but, perhaps not a specific topic area to discuss the Brush. Please indicate where I might find more directly related focus. I naively thought vascular access included HD catheters. Though I can see the general relationship. thanks again
David

David,
Vascular access in dialysis can be a fistula (own vessel artery to vein connection) graft (PTFE or other materials artery to vein connection) and catheters(central venous no arterial inflow). When we say AV access we mean arterial to venous vascular access like the fistula and graft. When we say VA or vascualar access we means all types. Sorry to confuse you.
The brush can only treat a portion of a fibrin sheath at the tip of the catheter- but the higher up segment would remain and re-form to block the tip? The fibrin sheaths are usually attached higher up on the catheter by the vessel wall and then trail down the catheter to the tip. So would this be used inplace of Uro to treat the occlusion?
What is CHICA conference?

Hello again Deborah,
I am truely a rookie in many ways and yet somewhat educated in catheter infection/occlusion. so.....regarding fibrin build-up..
the brush will at least allow the tip portion of the fibrin sheath to be removed ..which in some cases will allow access to be maintained until the desired physician is available for surgery vs. the 'doc on call'.
You draw the focus to an area that has future answers brewing [secrets for now...I promise to tell yoou if successful], but, I would hope to develop a better understanding in the occlusion problem in both internal and external blockage issues.
If I may....are you a USA practioner?...I am very interested in the reason/logic for different pratices vs..... the various international practitioners. I would also appreciate your advice on which segment of this site deals with HD catheters as a focus.... for both infection and occlusion...
apologize for the delay in responding....I travel out of the country a lot... but you may rest assured....baring a more spiritual existence.... I will respond!
so.....
thanks again
I look forward to yur response
ps....CHICA is the Canadian Hospital Infection Control Association.

Hi David,
I am a US based and have only worked in dialysis in the US. As a member of the NKF DOQI Vascular Access Work Group- I became familiar with the literature from the US and around the world on the various vascular access topics. I have traveled to Ottawa, Canada and visited a dialysis unit (hospital based) as well as seen a few dialysis units in France. The use of long term dialysis catheters is very different in the US then the rest of the world. We use many more catheters as the first access option for our new ESRD patients. This creates more problems with keep catheters working well at the high bloodflow rates used in the US (BFR or QB or 300ml/min is the minimal flow for a dialysis cath in the DOQI�s). Urokinase (before the recall issues) was given very freely in the dialysis units (q week, q treatment /all various ways were used). The use of dye studies has slowly gained favor in the US. A big turf battle between the specialties (surgery, radiology, nephrology) has prevented the best practices to be used for vascular access management. The reimbursement for procedures has also blocked the best care from being delivered. The basic systems are different.
The Vascular Access Area covers all VA issues and questions- you can start a new topic on and catheter issues you would like to get more information or questions form the site surfers. Both infection and occlusion would be under this general topic of VA. I know we have many US and international site surfers and they can help to answer your questions. The web site is US based- but what is so great is anyone can reach the site via the web- so it is unlimited! What a way to network!

For me the external fibrin formation is the bigger issue.