Twister® Reverse Flow Device


Vascular Access Dysfunction: A Serious Complication

Vascular access failure is the most frequent cause of hospitalizations in dialysis patients, and access thrombosis is a leading cause for morbity. 1 In addition, vascular access complications can contribute to as much as 25% of all dialysis patient hospitalizations per annum with the vast majority due to thrombosis.1,2 Vascular access dysfunction is also costly, with vascular access care estimates reported at $1.8 billion annually.3

A vascular access surveillance program provides information clinicians can use to extend the lifespan of the vascular access through planning, coordination and elective corrective intervention. Such a program may reduce the frequency of urgent procedures resulting in the need for catheters or hospitalizations. According to KDOQI Clinical Practice Guideline 4, “It has been shown that an aggressive policy for monitoring hemodynamics within AVG or AVF to detect access dysfunction may reduce the rate of thrombosis.”1

An effective surveillance program may allow the early detection of patient access dysfunction before the patient develops complications. Coupled with a program of elective stenosis correction, access thrombosis rates decline approximately 50-75%.4

Vascular access dysfunction may lead to patients being under-dialyzed, resulting in lower Kt/V and an increase in morbidity and mortality. Every 0.1 decrease in Kt/V is associated with 11% more hospitalizations and 12% more hospital days.1

Through routine and consistent use of a vascular access surveillance program, staff may easily identify access dysfunction through a combination of physical assessment and intradialytic monitoring. A simple way to implement such a program is using the 2008® series hemodialysis machines with Access Flow feature and the CombiSet® True Flow bloodline with Twister device.

Vascular Access Surveillance with a Twist

The CombiSet True Flow bloodline with Twister reverse flow device makes monthly blood flow measurement as simple as a twist. The Twister device is designed to perform optimally when used with our 2008 series hemodialysis machines, which account for over 90% of machines used for hemodialysis today in the U.S.

Developed with patient and staff safety in mind, the Twister device’s closed-system design eliminates the need to disconnect the bloodlines manually, thereby reducing the risk associated for blood and bloodborne pathogen exposure. When used in conjunction with the 2008 series machine and integrated Online Clearance (OLC) with Access Flow software, the Twister device provides an economical, effective, and simple solution to your facility’s vascular access surveillance needs.

How the Twister Device Works

When using a 2008 series dialysis machine with OnLine Clearance (OLC) with Access Flow software, access flow measurements can be obtained by following the screen prompts provided throughout the process.*

*For complete instructions, please reference the user’s manual for the specific model 2008 series hemodialysis machine you are using to perform the test.

The Solution is Simple

For more information on our Twister reverse flow device, CombiSet True Flow bloodline series, and other vascular access surveillance resources, call 1-800-323-5188.

Looking for more information on vascular access monitoring and surveillance? Contact your Fresenius Renal Technologies sales representative to obtain a copy of our Vascular Access Monitoring and Surveillance guidebook.

1. National Kidney Foundation, “NKF K/DOQI Guidelines: Clinical Practice Guidelines and Recommendations, 2006 Updates Hemodialysis Adequacy, Peritoneal Adequacy, Vascular Access.” Available: here. Pages 241-242, 273-301.
2. Rios, Danyelle et al, “Hemodialysis Vascular Access Thrombosis: The Role of Factor V Leiden, Prothrombin Gene Mutation and ABO Blood Group.” Clinica Chimica Acta, 412 (2011): 425-429.
3. Chang et al “Intradialytic Hypotension and Vascular Access Thrombosis”. Journal of the American Society of Nephrology, 8 (2011): 1526-1533.
4. Sands, Jeffery, “Vascular Access Monitoring Improves Outcomes”. Blood Purification, 23 (2005): 45-49.