I have a pt who repeatedly has an ABF > 3000 per crit-line monitor. If cardiac output is about 4-6L/min and the pt's access receives maybe 15-25% of the cardiac output, what's going on in this pt? The pt doesn't complain of steel syndrom to the extremity. Is something wrong, maybe cardiac status that The docs and I should work this pt up for? Is the monitor correct? the pt weighs about 63 kgs. Are my numbers for cardiac output and access correct? The docs are questioning this situation

Have you actually measured the cardiac output or are you assuming based on text book values ?

Lauren, i am an outpt facility. I am going by textbook info for cardiac output. So I really don't have hard and fast facts on this piece of data for this pt, but it seems that ABF of > 3000is awfully high. What are your thoughts?

Dear RNCNN and Lauren,
This is a tough one. I would believe the Crit-Line. I do think that this patient should have a Cardiac Echo to determine true C.O. Has the Nephrologist ever considered banding the access? Could this patient possibly have high output CHF?

Yes, I agree that the ABF > 3000 is high. I would expect if this was an accurate reading the patient would be symptomatic. Have you re-checked this value ?

The Transonics can do Cardiac Output in the outpatient setting as well as access blood flow measurement, recirculation and blood flow monitoring.

RNCNN, do you have access to a Transonics ?

Nancy LePain, can the Crit-Line do Cardiac output ? If not now will it be able to do this in the future ?

Lauren, I do not have access to a transonics. I have completed the ABF on this pt for two months in a row, having done ABF at least four different times, different tx days, no low b/p, no symptoms etc... I always get >3000. Pt says she feels fine. Will discuss in detail with MD. Appreciate any info from anyone on solving or understanding this situation better

Is it possible that the graft is reversed and you dont know it therefor getting this high reading?? That is what happened in our unit. Just a thought

Sheri makes a valid point. You should discuss with the Vascular Surgeon who placed the Graft.

Sheri, nancy, Thanks for the info we haven't explored the thought of the access being backwards or placement issues. Will definitely follow through.