Bill Peckmann high pump speed damage to AV/f

Ok after two weeks of research, this it what I have been able to find out. In a AV/F blood flow in a radiocephlic AV/F is approximately 700 to 1,000 mL/min while he upper arm AV/F flows are much higher, ranging from 1100 to 2000mL/min but can reach 300 ml/min.In the AV/f blood returns to the heart by multiple collatraials and not just the main vein. So with this in mind a blood pump speed off 400 to 600 we would think that this is no problem, but it is. In the three articles that are reference they talk about the jet stream that is cause by the needles. In all case they show and observed turbulence cause by the needles. This it what cause damage to the walls of the vein". “The Journal of Vascular access (2009): 10: P-157-159” Dialysis needle hemodynamics in anterior-venous fistulae: a technical report. No 2 Journal of biomechanics 40 (2007) 2158-2166 Effects of venous needle turbulence during ex vivo hemodialysis on endothelial morphology and oxide formation. No 3 Journal of biomechanical engineering Dec 2005 vol 127 1141-146 'Turbulent flow evaluation of the venous needle during hemodialysis" "The National kidney foundation guidelines suggest puncturing the AV/f under 25 degree angle. Once the puncturing are preformed the needles should be ideally parallel to the vessel wall. In practice the appear to be oriented towards the anterior wall probably due to the weight of the needles and the lines. My opium is that i promote and use buttonhole to overcome this problem. The Freedom paper by Nexstage shows that longer and more frequent dialysis is the key.
Conclusion; Slow done the pump speed and increase the time on dialysis.
Thanks Bill for the question it has led me into a whole different aspect of cannulation and access development

I too thank you for your information… I have a little other question along this line. When Bo’s BFR is at 310, we have such low V pressures. He V is at 50’s and A is 100’s. Im still wondering if those ‘V’ #'s are ok or is he one that needs faster speed to keep that up just a bit. Heck, i cant seem to go lower because of this. His tx time is 3:40 at this time. FF 32 and taking of .8 - 1 1/2.

The problem I have with how this info is presented is that ml/min is a volume measure but talk of jet streams and such, relates to speed of the blood flow not withstanding the amount of blood flowing. However, actual speed measures are never discussed in any of the papers.

Are you talking blood pump speed such as 250-500 etc , if that is the case yes they talk about the pump speed.

Those number are always given as ml/min but that’s not a speed measure, that’s a volume measure. People say it as if it was speed, but ml/min is a volume measure. Again, for it to be a speed measure it would have to be distance/min.